Extra skin on the sides and flat bottom 1 year post - how can this be fixed? (Photos)

Question

Hello! I am 1 year PO from UTM implant exchange with skin removal And mesh, no lift I was left with extra tissue on the sides and a flat look at the outer bottom How can this be fixed?

Semih Yildiz, MD, FEBOPRAS · Answer

Your photos show flattening at the outer lower portions of both breasts, along with some lateral skin and tissue excess and asymmetry. The exact cause cannot be determined from photographs alone. Possibilities include a residual loose skin envelope, implant pocket position, tight or scarred lower-pole tissue, implant dimensions, or the effect of the capsule and mesh. At one year, the tissues are usually mature enough for an in-person revision assessment. Depending on the examination, correction may involve targeted lateral skin excision with extension of the existing scar, pocket tightening if an implant has shifted outward, selective release of a tight lower pole, adjustment of the capsule or mesh, and/or limited fat grafting to smooth a contour depression. A lift is not automatically required; it depends on nipple position, skin excess, implant position, and the result you want. Because you have had implant exchange, skin removal, and mesh placement, bring the operative report and implant details to a board-certified plastic surgeon experienced in revision breast surgery. An examination is needed to decide which layer is causing the flat area and to discuss scar placement, implant risks, and realistic symmetry.

Mert Demirel, MD · Answer

Since you are a full year out from your implant exchange, what you see now is your settled result, so it makes sense to address it rather than wait longer. The two issues you describe often go together and usually have a mechanical explanation. Extra tissue on the sides typically means either residual skin and fat that was not fully addressed at the outer edge of the previous surgery, or breast tissue that has been pushed outward. The flat look at the outer bottom of the breast usually means the implant is not filling that part of the pocket &mdash; either because the pocket is tight there, because the mesh is supporting the implant in a way that restricts the lower-outer curve, or because the implant is sitting slightly more toward the middle than the natural breast border.The encouraging news is that both problems are correctable, and often with less surgery than your previous operations. Depending on the examination, the excess on the sides can be treated with liposuction alone if it is mostly fatty, or with a small skin excision if there is a true fold of loose tissue. The flat outer-lower area can be improved by adjusting the pocket so the implant fills that zone properly, by softening the tight area near the mesh support, or by adding a small amount of fat grafting to round out the curve. Which combination is right depends on what is actually causing the flatness &mdash; implant position, pocket shape, or thin tissue &mdash; and that can only be determined by examining you, especially since mesh was used in your last surgery and any revision needs to respect that support.The most suitable next step would be an in-person consultation with a board-certified plastic surgeon experienced in post–weight loss body contouring. During a physical examination, your skin quality, the areas of looseness on your abdomen and beneath your breasts, and your breast shape can all be properly assessed, and a clear plan can be mapped out &mdash; what to combine, what to stage, and what result you can realistically expect at your current, healthy weight.

David Shokrian, MD · Answer

Hello, and thank you for your question. Based on your photos, there does appear to be is a discrepancy between the right breast and the left breast, with flattening and excess tissue along the outer lower portion on one side. This can occur for several reasons after revision breast surgery. One possibility is that the mesh and the current implant pocket are contributing to the breast shape, while another is implant malposition or rotation within the pocket. Imaging with an ultrasound or MRI can help determine the implant's position and confirm whether it remains properly oriented and intact before planning the next step.
In my experience, one approach to consider would be converting the implants to a pre-pectoral, or above-the-muscle, position. This allows the pectoralis muscle to return to its natural position while placing the implant beneath the breast tissue, which can help restore a more balanced contour. Depending on your examination and imaging findings, your surgeon may also incorporate a breast lift to tighten the implant pocket, improve support, and enhance symmetry. Revision breast surgery is highly specialized, so I recommend consulting with an experienced plastic surgeon who performs a high volume of breast revision procedures. I hope this information is helpful, and I wish you the very best with your next steps.
David Shokrian, MD Plastic & Reconstructive Surgeon

Yasemin Aydinli, MD · Answer

One likely explanation is that the implant has turned or flipped inside the pocket &mdash; so the base is now facing the wrong way rather than sitting flat. That can create exactly the kind of odd, uneven look you're describing, with fullness where you don't want it and flatness at the outer bottom.
A second possibility is that the implant has dropped lower in the pocket &mdash; this can happen even under the muscle &mdash; and if the breast tissue over it isn't very minimal, that descent can produce this unusual "double-bubble" type appearance. That said, the flat way it's sitting makes rotation the more likely of the two, and this is especially something that can happen with a microtextured implant.
The best way to tell them apart is imaging &mdash; I'd recommend an ultrasound and, ideally, an MRI, which show the implant's position and orientation clearly and confirm it's intact. Whatever the cause turns out to be, though, this looks like it will need a revision with new implants to put right.

Camille Cash, MD · Answer

At one year post op you have your final results.  Imaging studies could help determine what is occurring "behind the scenes" leading to the appropriate action for correction.  Anything from implant repositioning, pocket correction, or additional revisions may be indicated.

Manuel Diaz, MD · Answer

Hello. Based on your photo, it appears that you have excess tissue laterally and a loss of fullness in the lower outer portion of the breasts. 
In your case, a revision breast surgery would likely be the best option. This may involve repositioning the implants, removing the excess tissue on the sides, and performing a breast lift if necessary to improve the breast shape, restore fullness in the lower pole, and achieve a more balanced contour.
The exact surgical plan will depend on your current implant position, skin quality, and the amount of tissue available, so an in-person evaluation is essential to determine the best approach.

Mats Hagstrom, MD (license on probation) · Answer

The more revision surgeries you’ve had the more unlikely it is you’re going to have a quality outcome.
At this point the situation is Hailycomplex and only various skills to plastic surgeons will be able to give you a significant improvement.
Having used successively, large implants may have contributed to the outcome.
I’m guessing the amount of breast tissue that you have is quite small and most of your breast is actually implant.
There’s no single procedure that’s going to fix this.
The entire breast needs to basically be taken apart. The mesh probably needs to be removed and replaced, and there may be. Need to be direct skin excision or an internal closure.
Finding the right plastic surgeon, for this may be difficult.
The best surgeons to do revision surgery are often the same surgeons to do the breast primary augmentation.
Look for plastic surgeons who focus exclusively unpressedaugmentations, and have at least one or two decades of experience.
Sometimes plastic surgeons who do a lot of breast cancer reconstruction are very good at all aspects breast surgery.
I suggest you schedule a lot of in person consultations with plastic surgeons, whose practice is very strong and breast augmentation surgery.
I’m sorry you yourself in this situation.
I wish I could be more optimistic.
The importance of provider selection for primary procedures cannot be over emphasized.
Ifthe procedure is done correctly, the first time and then revision surgery will not be needed.
 Once revision surgery is done the patient is at risk for having problems again and again.
This almost always stems from the first procedure, having been done correctly.
Mats Hagstrom MD

Extra skin on the sides and flat bottom 1 year post - how can this be fixed? (Photos)

Answers (7)

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