Was told “this is the best I can get”. What are my options?

Question

5’6, 135lb F Primary augmentation Silicone High profile Allergan 345cc Infrmamary incision Subglsndular Wan Was told this is the best result I can get. Any recommendations, they are continuing to “sag/drop” and pulling and resting on my rib cage and becoming uncomfortable. Want more upper pole and medial cleavage Wanted large 400cc was told this as big as I could go Starting to get grooving on bra line trying to get cleavage in a bra 6 mon post op

Gerald Minniti, MD, FACS · Answer

Your photos exhibit an implant that is in good position relative to your soft tissue envelope. They are not dropped out or sagging; you have plenty of upper pole fullness form the implant. Although your nipple to fold distance is slightly inadequate for this size implant, you look good. What will likely make you happier is a larger device, which is now obtainable due to pre-stretch from the current implants. Two words of caution: 1. Going to 400 cc will barely be perceptible, so if you are truly considering a revision surgery, you'll need to think bigger and sizers (either homemade rice sizers or in office purpose built ones) would be appropriate to determine the implant size. 2. Going bigger is going to stretch your soft tissue envelope out further, putting you at risk for rippling, malposition, and capsular contracture, the latter you are already higher risk for because your implants are over the muscle. You need to really think about the long game here. Bigger implants create bigger problems, especially years and decades later.

John Michael Thomassen, MD · Answer

You may consider a breast lift if you are worried about breast ptosis (sag/drop).  With larger implants you may experience further breast ptosis due to the weight of these devices.

Gary M. Horndeski, MD · Answer

The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, your implants can be exchanged for smaller ones.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revision breast surgery.  Unfortunately, what happened to you has happened to many women who are told that they can "fill up" the skin envelope and not have a breast lift.  Ultimately, the weight the implant continues to drag on the skin envelope, and the breasts continue to sag.  In your case, you would benefit from an internal bra-capsulorrhaphy,  reaugmentation to a larger implant, and breast lift.  You are an excellent candidate for this.  Best wishes to you.

Daniel Barrett, MD · Answer

Dear floridagirl1995,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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

Bruce K. Smith, MD · Answer

There is always something that can be done to improve a result after plastic surgery. With subglandular implants which make the breast heavier, the skin can stretch and the breasts can become droopy or ptotic. In my experience, sun exposure and tanning bed treatments are a risk factor for this problem. The UV exposure causes the collagen and elastin to breakdown even in young patients and the skin alone is not a very good bra for holding up an . Other risk factors include smoking, pregnancy, and weight loss. If you are willing to accept additional scars on the breasts, a mastopexy (with or without mesh), will probably be required to meet your expectations. Good luck to you.

Darryl J. Blinski, MD · Answer

Thanks for excellent posted photos., it really helps. There are a few issues presented. 1. implant should be sub muscular placed; 2. I would offer High Profile 425-475 exchange; 3. might recommend full lift as a secondary operation to try to avoid scars. Best to seek in person or virtual consultations with private practice boarded PSs. Fees in the $8,000+ ranges.

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