Sagging after lift and implants! Help! (Photo)

Question

I received a lift and implant about 8 months ago. My breasts had gotten droopy from pregnancy and affected my self-esteem. I wanted to achieve perky, round, full breasts with lots of round volume. I wanted them to look fake, in regards to the roundess on top. I feel they have dropped back to my old breasts just bigger. The nipple placement is better. I still have to wear a bra for perkiness. I received 450cc saline over the muscle high profile, with an anchor lift.

Richard A. Mouchantat, MD, FACS · Answer

You have chosen a look that requires strong tissues to stay supported. The size of the implant is an issue with respect to accentuating that problem. At this point a full revision with a high profile textured silicone implant and support with Strattice to support the implant would be the best way to achieve your desired result. The longevity of the results would be excellent with the additional cost of the Strattice. Strattice is made of porcine dermis and has a strong collagen network that acts as a graft to support the implant pocket. Changing over to silicone may have less of a bouncing effect on the tissues supporting your implant.

Richard J. Bruneteau, MD · Answer

Unfortunately, gravity is an unrelenting force that continuously impacts the female breasts. Even when patients undergo breast lift surgery, recurrence of breast sag is inevitable to some degree. Several factors have been associated with the early recurrence of breast sag including the use of large implants, sub-glandular implant placement and poor skin tone. Your history suggests that all of these factors have been operative in your case.For this reason, revisional breast surgery would be appropriate to correct your recurrent breast sag. Under these circumstances, smaller breast implants placed in a sub-muscular position would be helpful. This procedure could be easily combined with a revision of your previous breast lift as well.Although breast sag is inevitable to some degree, these steps would definitely slow the rate of progression of this problem.  In addition, the addition of a small breast implant in a sub-muscular position might add some longevity to upper breast fullness as well.If you're considering correction of this problem, consultation with a board certified plastic surgeon is appropriate. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for the picture. It's going to be hard for you to achieve around St. Louis because the skin of your breast has been stretched out from changes due to pregnancy. If you truly want to look better you need to more than likely remove the implants and only have a breast lift

John Nguyen, MD, FACS · Answer

Very large implants, augmentation mastopexy, poor skin quality can all lead to recurrence of breast ptosis.  I would suggest revision mastopexy and conversion to a much smaller implant.  In my practice, I have also used Stratus or Seri to create an internal supportive sling for the implants to help prevent sagging.  Good luck and be safe.  John T. Nguyen, MD, FACS, FICSDouble Board Certified Plastic Surgeon

George Marosan, MD · Answer

You showed that your tissues cannot support a large implant. Going larger to fill the upper poles and look "fake" will work for a short time until your tissues relax and stretch and the implants drop again. You might benefit from a vertical lift, without nipple repositioning to cone the breasts and raise the implants to a higher position. After surgery, the lower poles of the breasts should be taped and also wear a supportive bra for at least one month. Good luck.

Parit A. Patel, MD, FACS · Answer

Thank you for your question and photos.  This is a tough situation and sorry that you did not get the result you were hoping for.  Unfortunately, when you place a large implant above the muscle, over time, the weight of the implant will cause the breast to "bottom out".  This is what you are noticing in the post operative photo, despite having a lift at the same time.  
One option to improve things is to undergo a revision with a smaller implant and to create a new pocket under the muscle.  Depending on your skin quality, you may need a skin substitute to support the breast tissue over the implant to prevent the implant from "bottoming out" again.  
I recommend following up with your board certified plastic surgeon to discuss options.  Good luck and I hope this helps.

Frederic H. Corbin, MD (license restricted) · Answer

Unfortunately your skin has lost elasticity and relaxes after a time causing you to lose upper pole fullness. That is also why literally all procedures for aging would benefit from being redone with passage of timeDr Corbin

Thomas M. DeWire Sr., MD (retired) · Answer

Unfortunately, mastopexy with implants will not cure the tendency to sag. The main shortcoming of
mastopexy, with or without implants, is that it must use the existing tissues
that have already shown the tendency to sag, unable to support the weight of
the existing tissues, and aggravated by weight fluctuation and pregnancy. 
Eventually all lifts will stretch again to some extent, some requiring
revision, even early.  Placing implants over the muscle, which means that
the implant weight is completely unsupported except by the stretch-prone skin,
usually leads to recurrent sag, and often quickly, which is among the reasons
that I do not offer that option.  While revision is possible, it
often requires conversion to submuscular placement, preferably without muscle
origin release, as that will provide lasting internal bra-like support by the
intact muscle, and then suturing the space over the muscle closed to prevent
the implants from flipping back over the muscle. Generally the lift also needs
to be revised, but there is less vascular supply to the skin and nipple with
implants over the muscle, so such revisions must be done carefully, and
sometimes as a separate procedure if the remaining breast tissue and skin are
too thinned out by the stretch. This approach, leaving support muscle intact, may be problematic with immediate repositioning of large implants, however, as the submuscular space may not have enough room to do this in one step.  I am sorry to see that this happened, but your experience has already proven that expecting to maintain perky upper pole fullness in an augmentation mastopexy situation, particularly with implants over the muscle, may be an unrealistic goal.

Robert Sleightholm, MD - Account Suspended · Answer

Comparing the pre op photo to the post op photo, the superior pole is at the same level approximately.  It is not possible to move the superior pole of the breast higher than it's anatomical location with a lift.  Your tissues cannot support an implant that size.  Over time the tissue will stretch with the weight of the implant.  Resection of a portion of the inferior pole may improve breast shape.

Richard P. Rand, MD, FACS (retired) · Answer

You show the problem of going to try to get too full and round with implants when you also need a lift. The need for a lift means your tissue elasticity is not good. When you try to push the size and fullness with a big heavy implant there is typically an initial period of fullness (as in your photos) followed by descent and loss of all that fullness leaving a bottom heavy breast. Be careful not to try to solve this by going bigger as this usually just makes things worse.

Sagging after lift and implants! Help! (Photo)

Answers (10)

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