HELP!!! What is this and how do I get it fixed??

Had breast aug 5 months ago along with a keyhole lift.  Post weight loss surgery and two kids...horrible sagging breasts.  I wanted 375 to 425 surgeon put in 335 and now i have attached pic... What is this, how do I fix it?  Original surgeon wants to do sutures and does not want to put in slighly larger implants as paid for (roughly 400) second surgeon says first one didnt do lift properly and I need a revised lift which would hold 400cc.. And most important does gel or saline make a difference.  have gel but would do saline second time around to get fuller higher appearance AND less chance of reccurance... HELP HELP revision is scheduled for next week and I am not 100% we are doing the right thing...

Doctor Answers 5

Crease and lower breast deformity needs correction

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This problem can occur for many reasons that are too complicated to elaborate. However, I agree with the other Plastic surgeons that have responded indicating that the size of the implant is a very important factor. If you want to improve your success rate with revisional surgery, the implant can not have a larger diameter than the natural width of your reshaped breast. Furthermore, re-tightening your breast fold is only as strong as your tissues-a feature that your surgeon can not change. Your tissues will more likely "give away" again with a larger and heavier implant in place. I strongly disagree that you can have any size that you want without seriously increasing your risks of complications and and your rate of revisional surgeries in the future.


Dr. Mosher

Vancouver Plastic Surgeon
4.5 out of 5 stars 34 reviews

IMF crease

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Looks like you need your infra-mammary fold reconstructed. Once this is done, the pocket will be obviously smaller than now and the decision about new sizing is best discussed with the surgeon fixing your IMF fold.

The lift itself may not need to be redone entirely, just make sure you consult with a Board Certified Plastic surgeon familiar with IMF fold reconstruction.

Keyhole lift problem--how to fix it.

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Your problem is not one of implant size or composition. Silicone gel implants are the best for softness, lack of rippling, and avoidance of deflation. Stay with silicone.

Size is another issue. You can be any size you wish! 65cc more or less is NOT the issue here, so I'm not sure why your surgeon wouldn't use the ones you wanted. Actually, for more upper pole fullness, you may need to go to around 500cc. These would also have increased base diameter (moderate profile recommended) to better decrease your cleavage width.

But the real issue here is the double bubble. I don't need a physical examination to see what is happening--your photograph shows enough. Your surgeon or you (or both) chose what you call a keyhole lift (most surgeons and patients call this a vertical or "lollipop" lift). This type of lift is designed to avoid the horizontal crease scar that would have avoided this concern (and is necessary in order to correct it). Look at how long the vertical limb scar is. It extends to BELOW your natural inframammary crease, as does your implant pocket. The pocket needs to be closed off inferiorly (with sutures), and the excess skin below you natural crease needs to be removed. Yes, this means more scars, but that was the problem in the first place--your breasts were previously stretched out and then deflated with your weight loss, leaving you with too much skin in ALL dimensions. I wonder why your surgeon thought he could remove skin in only one dimension (horizontally, with a vertical-only scar) and not end up with too much skin in the vertical dimension (and a scar that extends beyond your proper crease)?

This is a difficult problem only if surgeons try to keep fitting round pegs into square holes (or more accurately, trying to create pleasing 3-dimensional-shaped breasts with skin removal in only one dimension). You needed a full Wise-pattern ("anchor") breast lift (mastopexy) plus implants adequate to fill out your "new" skin brassiere to the desired (safe) size. You did not ask for 700cc implants, which I would expect your surgeon to downsize. But 400 to 335cc? This took off just 2 ounces! You have too much skin (still), not too-heavy implants!

Hold off on this revision until you get the plan right, or you will end up with yet another revision being necessary. For an example of one of my patients with a similar issue click on the link below. Please let us know how this turns out, whether you follow my advice or not. Good luck!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

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You have a fold problem. Bigger implants make a bigger problem.

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I agree with Dr. Baxter. You must examined before anyone can tell for sure what is happening. If you do have a double bubble as he mentioned, be very careful about a larger implant size this can make the problem much worse. It is most likely that your original surgeon put in the size implant he or she did because of that very worry. Make certain that whoever you are seeing is a Board Certified PLASTIC SURGEON. This is a somewhat complicated problem and you need to be certain that you are in good hands.

How to fix double bubble breast implant problem

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First, no one can give you specific advice without seeing you personally, but what I can say from the picture is that you have one version of what is known as a double bubble. Most likely, the original bottom fold of the breast is where the groove across the breast is now. One reason this occurs is trying to make the pocket large enough to accomodate the implants by lowering the fold, so it isn't as simple as just choosing a size. If the diameter of the implant is too large for the base diameter if the breast, then troubles like this can result. Fixing it usually involves sutures  inside to raise the bottom fold up (called a capsulorrhaphy), but the implant size depends on your measurements.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

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.