Do I need a revision? (Photos)

These photos suggest a combination of recurrent skin and tissue laxity with possible implant pocket or shape issues, rather than a simple scar concern. The nipples and lower breast tissue appear low and elongated in the images, but an in-person exam is needed to judge implant position, pocket stretch, and skin quality.
If you are still early after surgery, it is usually best to let swelling and scars settle unless your surgeon sees a complication. If you are already well healed, a revision consultation would be reasonable and may involve tightening the lift, adjusting the pockets, changing implant size or profile, or sometimes removing/replacing implants depending on your goal. Start with your operating surgeon for records and timing, and a second opinion is fair if the plan is not clear.

Dear sherryrose29,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello, in addition to doing nothing you have a few options. First, since we don't know how long it's been since you had the implants your surgeon needs to rule out a capsular contracture which can cause the implants to sit higher than they should. If the implants are in good position and soft it appears you have some excess natural breast tissue that is falling off the face (center) of the implant. Repeating the breast lift and also removing breast tissue from the bottom of the breast if possible (based on your surgeons previous technique) can give better shape as it now relies more on the shape of a round implant then your natural breast tissue. Keep in mind that if you should remove the implants at some point you will have less breast tissue. Good luck.

You have a very nice improvement after your mastopexy and breast augmentation. However, one of the breasts and the nipple seem to be slightly lower than the other. That breast also seems a bit boxy. Yes, a minor breast revision should help you to achieve better symmetry.

The question of the need for revision is not simply a yes or no question. It is multifactorial. Revision is a question of patient satisfaction. It is also an issue of whether or not a surgeon believes a result can be reasonably improved.

Revisions should be delayed 6 months to allow for a final result to settle.

Based upon your photos, you have a very reasonable result. There are mild asymmetries which may be amenable to improvement (depending upon how far along you are in the recovery process).

As always discuss your concerns with a board certified plastic surgeon (ABPS).

There are some aspects of your result that may be tweaked, but it is a very important decision whether to go back to surgery. Only you and your surgeon can decide on the best course. This largely depends on your expectations and what the plastic surgeon thinks they can accomplish. I think a conversation is the only way to proceed.

At this time, I recommend explantation and breast lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Based on the pre-operative photos, your surgeon did a nice job with the augmentation and addressing the breast ptosis and preserved the blood supply to the areola on a superomedial pedicle. Combining an augmentation with a breast lift at the same time is a fairly challenging surgery, so it has a slightly higher revision rate than either of those procedures alone. If you were to undergo a revision, a surgeon could raise the areolas a little bit and round out the bottom of the breasts, but again, that's a decent result for a single procedure.

There is a big improvement from your pre surgery breasts, but there is some room for further improvement with shaping. If it is bothersome to you a revision can be explored but you would have to decide if it is worth it.