Your situation is pretty complex. Simply, the idea of having an augmentation in conjunction with a breast reduction is fairly unusual. There’s a lot to go over and you’re not being well served by opting for virtual consultations. In fact, posting on this website should not be considered a consultation. I advise in person consultations exclusively. To getThere’s a lot to go over and you’re not being well served by opting for virtual consultations. In fact, posting on this website should not be considered a consultation. I advice in person consultations exclusively. To get a proper second opinion consultation come prepared bring with you a complete set of proper before and after pictures and copies of your previous operative report. These are all part of your medical record and that is obtainable by requesting it from your current provider. You may as well just ask for the entire medical record and make sure that includes all before and after pictures taken and the operative report. If you want your breast to have projection, then you’ll need to keep implants. Fat transfer is not at all appropriate in your case. Fat transfer will only make your breast larger, which is the opposite of what you are attempting. The only reason to have implants is to give your breast projection. It would be helpful to understand what your discussion was during the consultation and who and why chose the size implants that you have. There are limits to how much breast tissue can be removed during a breast reduction. Doing a breast reduction with a breast augmentation and a breast lift is a high risk procedure. If the surgeon tries to remove too much breast tissue, you could have disfiguring complications. In your case, the problem, as I see, it is the size of your implants. It may be possible to further reduce the size of your breast and decrease the size of your implants. That is probably the way to go. If you don’t care about breast projection, then have the implants removed and consider reducing the breast further. If you want aesthetically good looking breast than the implants need to be kept in place. Do not have the implants removed then change your mind and put in implants later. It seems to me that there may have been a lack of proper communication regarding what you were hoping for with this procedure. You should also recognize that the procedure is fairly complex and not all plastic surgeons would do this as a single operation. Some plastic surgeons would do this as a stage procedure to minimize the chance of complications. May be a good consolation is the fact that you healed well without having complications. It shouldn’t be that difficult to get an improved outcome, making your breast smaller, whether it’s from changing the implant size, removing more breast tissue or a combination of both. If you like your current provider, then continue working with him or her. If you have lost faith in your current provider, then get second opinion consultations. It doesn’t look like anything was done wrong, and perhaps the problem was simply miscommunication or misunderstanding of what you were hoping to achieve. The chance of having revision surgery after the kind of procedure you had is in reality quite high. I would say probably 40% of patients having a reduction with augmentation and a lift are going to need some type of revision procedure. As I mentioned previously, some plastic surgeons would even plan undoing this as a staged procedure.I see absolutely no indication for fat transfer, and I would be careful with removing your implants unless you know you’ll be satisfied with breasts that lack projection. Best, Mats Hagstrom MD