What would be my best option for breast implant revision? (photos)

Question

In 2020, I had a breast augmentation with donut lift. They rapidly dropped and now I think I have bottomed out. There’s also a big gap in between. I also am thinking of going larger for implant size. My surgeon stopped responding and won’t help, so I’m looking for a new surgeon. What is the best way to close the gap in between the breasts and have them be more perky? Is Galaflex needed?

Richard Baxter, MD · Answer

It looks like you may have had a tubular breast prior to surgery, which is a short distance from nipple to bottom of the breast and a wide gap between. That results in a trade-off between implant diameter and risk of bottoming out due to lowering the fold. The implants should be moved up, with a capsulorrhaphy (internal sutures), and internal bra with Galaflex if the the tissues are thin over the lower pole of the breasts. You may have to settle for a wider gap between the breasts than you want though.

Donald R. Revis Jr, MD · Answer

Good morning,
You do have bottoming out. This is commonly seen in overdissection of the pockets during surgery. I correct bottoming out with the Original Internal Bra, my strong permanent internal suturing technique. I first developed this technique over 20 years ago, and today it is the most common revision procedure I perform, at least 5-6 times a week- it works and it lasts! We can add a sheet of Strattice mesh as well, which does provide additional strength and support, but the key is the suture repair with the Original Internal Bra.

Daniel Barrett, MD · Answer

Dear NeedaMMO,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

At the time of your operation, your breasts were quite low on the chest wall. This required your surgeon to place the implant quite low in an attempt to lift the breasts with a donut lift, which was inadequate. At the time, the safest thing to do is remove the implants, plicate the pockets, wait 6 months and then do a repeat augmentation. I would not recommend larger implants.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Harry T. Haramis, MD, FACS · Answer

Unfortunately, post op changes can affect results. Some anatomy- such as wide space can be improved but not eliminated.

Your left appears to have moved toward the armpit. Refining the capsule to move implant back towards middle should reduce the space inbetween.

The bottoming out would best be corrected with mesh such as Galaflex or Strattice.

Any other issues would be evaluated and discussed during consultation with your/a plastic surgeon, such as lift and/or implant modifications

Connie Hiers, MD, FACS · Answer

Your implants may be too heavy for your tissue. I would suggest not going larger, but go even somewhat smaller and tighten your lower pockets.

Darryl J. Blinski, MD · Answer

Yes yu have bottoming defect bilaterally. I might recommend removal of implants with placement of an ACDM (any brand though all are expensive) with larger implants. As for wide cleavage that is more from your chest wall anatomy and widely spaced breasts. Expect fees in $20,000 ranges..

Douglas J. Raskin, MD (retired) · Answer

Greetings,
There are two main issues of concern which you noted in your question.  Your consultation and examination by a plastic surgeon would be most helpful for you.  The bottoming out of your implant(s) can be addressed with surgical re-anchoring of your creases.  Larger implants likely will not help you to maintain this surgical correction.
Wide spaced breasts after augmentations can remain wide spaced; your pre-op photos will demonstrate if this was a pre-existing anatomic issue.
Best Regards,

Richard P. Rand, MD, FACS (retired) · Answer

Yes, you have certainly bottomed out and need a repair to re-anchor the inframammary creases back down to the chest wall. Did you go to a real Am Board of Plastic Surgery surgeon? or was it just a "cosmetic surgeon"? You need a real one this time. Many times this can be repaired with sutures and some surgeons always prefer to use supportive materials. Going bigger at this time is not wise as it increases the chances of failure of the repair. Get it fixed and let it heal solidly, then consider going larger and closer to the midline.

What would be my best option for breast implant revision? (photos)

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