Feeling saggy and disappointed/frustrated-after donut mastopexy/implants. Will they get better when swelling goes down? (Photo)

I'm only one week post op- but feeling like since the first few days I've become super saggy looking... that was specifically the reason my PS suggested the lift and implant and now they are bigger and still saggy?? Will they get better when swelling goes down?? also- will the scars get more smooth and symetrical?? 34, 3 kids, 5,7", 130lbs, 375cc high profile silicone smooth.

Doctor Answers 4

Unhappy After Donut Mastopexy

The period of time immediately following the combination of breast lift and breast augmentation surgery is characterized by rapid change. During this dynamic period of time, swelling, muscle spasm, inflammation and the healing process itself all contribute to changes in the appearance of a woman's breasts. In some cases, swelling and muscle spasm can displace the breast implants in a superior direction when implants are placed beneath the muscle. This can result in an artificial upper breast fullness and inferior malposition of the nipple areola complexes. Based on your pictures, I believe this is a distinct possibility.

In some cases, superior implant displacement may be due to inadequate dissection of muscle insertions of the inferior portion of the breast pocket. There's no evidence that this has occurred in your case. With time, assuming adequate pocket dissection, these implants might return to a more normal position. Sometimes the use of a bandeau superiorly and massage can facilitate this process.

It may takes 3 to 6 months for these implants to drop into a normal position. If no progress has occurred by then, revisional surgery may be necessary. This would involve recreating the lower portions of the breast pocket.

It's important to have good communication with your plastic surgeon. Make sure he's aware of your concerns. He's familiar with the specifics of your surgery and will be able to give you appropriate direction.

A donut lift only offers limited correction

The periareolar lift, more commonly referred to as a donut mastopexy, does provide a small amount of improvement as far as lift is concerned, but it’s limited compared to a traditional mastopexy. It’s too early to guess at your final results at only one week post-surgery, but your breasts are more likely to look softer and fuller rather than higher and firmer as swelling decreases. I advise my patients to wait at least 6 months before considering a revision procedure. If, after that time, you still feel dissatisfied with your results, I suggest visiting your surgeon again to see what options he or she advises.

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 66 reviews

Against periareolar mastopexy

The periareolar mastopexy popularized by Benelli and Goes few decades ago is the most frustrating novelty and progress in cosmetic surgery (followed closely by endoscopy).

Essentially these are the flaws of the periareolar mastopexy in the best hands and correctly executed:
-flattened breast, "fried egg"-shaped
-"sun beams" around the areola due to the folds made to encircle a large circular edge downsized to a tiny periarolar edge of the wound
-overtension of the scar, leading to hypertrophic scarring of awful cosmetic quality, if not keloyd
-this overtension enlarges the areolas looking like cookies, furthermor elongated vertically most of times
-cutting away sking all around the areola leaves the areola in the same place, this means no uplift of NAC at all

You are not the first and will not be (unfortunately) the last to become victim of the seducing "scar-less" uplift. It is not a matter of finding the "best surgeon" to perform it, it is question of finding a surgeon who does not practive this technique.

Viewing your images you don't need a lift AT ALL, your ptosis was minimal, just for breast augmentation only, through hemi-perirareolar approach, anatomical shaped implants with macrotextured shell and cohesive gel filler, in subfascial plane.

Alejandro Nogueira, MD
Spain Plastic Surgeon
5.0 out of 5 stars 32 reviews

Early breast augmentation lift results

You had a periareolar lift which is the minor form of lifting when compared to a full lift which is a major lift with more scars. Implants will not lift the breasts.

It would be best to heal for 3-4 months and let the swelling go down. Quite possibly, you will want to consider having a full lift to better elevate the nipples and tighten the loose lower pole skin. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.