Mastopexy/Augmentation revision needed? (Photo)

I had a unilateral mastectomy to my left breast (the one you see on your right) in July, 2013 for DCIS/LCIS. In summer of 2015, I had reconstruction surgery: tissue expander surgery/implant transfer surgery/nipple reconstruction surgery. Contralateral breast has started to sag in the last month. I have gained only 5 lbs. since reconstruction last year. Does it appear to need a revision surgery? Can this be done in an in-office procedure?

Doctor Answers 1

A revision with right breast lift and fat grafting to the left will give you excellent symmetry


Congratulations on overcoming breast cancer!  Yours is a common situation in which one breast has been reconstructed with an implant and the other breast has not.  Over time your breasts will change shape and position differently - your left breast (reconstructed) will generally remain "fixed" in place because the wall of scar (called the "capsule") is quite strong and resists gravity from stretching the breast skin. However, your right breast will continue to age naturally; because gravity stretches the breast tissues then it will gradually come down (sagging is called "ptosis" in medical terminology). This creates asymmetry, which you have, and only surgery will correct it.  

On my analysis of your photo, the implant position in your left breast appears to be good. You just have some flattening of the inner breast cleavage area, as well as "implant show", meaning that you can see the inner and upper ridge of the implant. This is quite common after implant reconstruction particularly in thin women such as yourself. If you're pleased with the size of your left breast, then I strongly recommend fat grafting which is a technique in which I collect fat through liposuction of other areas of the body (such as the abdomen, flanks, inner and outer thighs), purify the fat and then carefully and precisely inject the fat into the breast skin. This softens and smooths the ridges so that the transitions from your chest to your breast are not as harshly ridged. The results are beautiful when done well. 

With regard to your right breast, I recommend a breast lift. It appears that your breast volume will match your left quite well, and therefore just reducing the stretched skin from the bottom will lift your breast tissue up. It's hard to tell whether you've had a lift in the past, and if you have then it's perfectly safe to do another lift. The scar remains in the shape of a lollipop - encircles the areola and goes straight down the bottom of your breast.  I believe you'll have a great result if these techniques are performed by a very skilled surgeon and it's also a plus that this is an outpatient surgery involving 4-7 days of recovery.
I wish you all the best in your search!
- Dr. Rad

Washington DC Plastic Surgeon
5.0 out of 5 stars 41 reviews

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