Breast augmentation exchange - a lollipop lift or a downsized augmentation with internal mesh support? (Photos)

Question

Hi there, I’m a trans woman with 10-year-old 550cc Moderate Plus implants placed through an inframammary incision . I currently wear a 40DD, but the implants have bottomed out and don’t look lifted. One provider suggested a lollipop lift, but another said I may only need a downsized augmentation with internal mesh support. I’d love a smaller, higher, perkier look with better cleavage. Given my limited natural tissue (due to inconsistent hormones), would I need a lift or could mesh and smaller implants achieve that? Thanks so much for your insight!

Daniel Barrett, MD · Answer

Dear Heygirlxo,
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

Wayne I. Yamahata, MD · Answer

Your nipples appear to be in a good aesthetic position. To achieve a higher perkier look would be best addressed by raising the implants with capsulorraphies. Smaller implants will reduce your breast size but will also result in some upper pole fullness loss. This is a tradeoff that you can address during further discussion with your surgeon.

Brian K. Reedy, MD · Answer

Thanks for your question! I think a lift is the wrong choice. Your nipple/areola is already too high on the breast mound with bottoming out. I would recommend a replacement with a bilateral capsulorrhaphy (with or without Galaflex) to support the lower pole and correct what you have going on. Best of luck!

Gary M. Horndeski, MD · Answer

I recommend explantation and 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 and nipple sensation (in 95%) is maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

If you are wanting a perkier look with more fullness at the top a lift should be considered.  An implant exchange to smaller implants can also help to prevent bottoming out from occurring again.  See a board certified plastic surgeon near you to learn more.  I've included a video I hope you find helpful.

Karl William Schwarz, MD · Answer

A lift will raise your nipple and areola to a higher position. An internal bra supports the implant. Your problem is not your nipple position, your problem is the implant has descended. You don't need a lift, you need the implant positioned in the correct position and that would best be achieved with a capsulorraphy to tighten and correct the pocket (especially with a smaller implant), and a mesh or strattice as an internal bra to support the implant.

Mats Hagstrom, MD (license on probation) · Answer

A breast lift is a procedure used to raise the nipple in relationship to the IMF (infra mammary fold)
Your nipple position seems good so in my opinion that you don’t need a breast lift.
Your implants have the bottomed out slightly so correcting this would be the way to go.
Correcting bottomed out implants is not easy or straightforward.
The chance of recurrence is high if the procedure is not done correctly.
 It can be done using permanent internal sutures with or without mesh or cadaver dermal products like Alloderm. 
By far, the most important variable is provider selection.
Ask your provider to open up their portfolio and show you their entire collection of it before and after pictures of previous patients who had this type of revision.
If you’re going with your primary plastic surgeon, then ask how often they do revision for bottomed out implants.
 Your current outcome is related to how the first procedure was done.
Anytime, excessively large implants are used the chance of undesirable outcomes, complications and need for revision surgery will go up. Having used smaller implants for the primary procedure may have avoided this outcome.
There are a lot of variables to take in the consideration.
Provider selection is in the end, the most important variable.
I generally recommend patients have multiple in person consultations before scheduling surgery.
It’s the patient’s responsibility to the provider.
Push them to show you how much experience they have and how typical outcomes turn out.
Best,
Mats Hagstrom MD

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