Why is my breast flat on the bottom after surgery? (photos)

I'm 1 month & 1 week post op with 520/560 textured unders. I expressed concern to my PS about the lack of lower pole fullness in my right breast. He said that's just how my breasts are, despite having LPF before surgery. He also said this is basically my final result. He said no more drop and fluff will happen. Why is one breast flat? Shouldn't there be more d&f to come because it's only been 5 weeks? My PS suggested either a crescent or perareolar lift to give me LPF. I don't know what to do??

Doctor Answers 11


To be totally honest, my feeling is that you will only get worse without another procedure (breast lift).  Your breasts have fallen off the implant, and in fact they most likely never were in position. It is true that a shaped, high profile, textured implant placed ABOVE the muscle can lift the breast in some situations.  However, your breasts have too much laxity and sagging to allow for that to happen.  Furthermore, they are clearly (from the photos) below the muscle and only a breast lift will help.  It could have been done at the same time, as I always do.  It avoids a second operation and gives a long term result just as good as doing it in two procedures...and it is far less expensive and avoids a second recovery.  However, some surgeons prefer to perform the lift at a second setting and that is purely surgeon's preference.  But this is where you are now and if you want the breasts you expected, the lift should give you a great result. I am sorry you're having to go through another procedure and wish all of plastic surgery was perfect every time.  Best of luck! 

Houston Plastic Surgeon
4.4 out of 5 stars 39 reviews

Breast Augmentation Results

Thank you for your question and providing great photos. At first glance, it does seem that while you have some mild droop to your breasts, you are also very low breasted. This means that your breast are positioned lower on your chest relative to your muscle. In this case, there is not much chance for the implants to round out at the lower pole as your muscle is sitting so much higher than your breasts and is now causing the breast tissue to hang off the implants. I recommend meeting with your surgeon to determine which route, whether switching the placement of the implants or doing some version of a lift, will be best to achieve your desired results.

Michael E. Ciaravino, MD
Houston Plastic Surgeon
4.9 out of 5 stars 132 reviews

Why is my breast flat on the bottom after surgery? (photos)

Thank you for your question and photos. In your before and after photos it appears that you had breast tissue #sagging and would likely benefit from a #breastlift. I suggest that you wait until you are 3 to 6 months postop to pursue a breast lift. This healing time will give you an a idea of what your #breast #augmentation results will be. I recommend that you speak with your #BCPS about a breast lift to be scheduled per his practice. Best wishes!

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Breast Lift Needed


Thank you for your question and photos. It is true that textured implants are not expected to drop and fluff very much- they are designed to lock in place. If you want the position of your areolas to be elevated you will need a breast lift. This can be done as a secondary procedure still.

All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Breast lift

I am sorry that your results are not what your were expecting. Your before pictures show every uneven breast and right breast very low. You could have had lift first and then implants( most patients do not want two surgeries) ,lift and implants together or implants first. You and your surgeon picked implants and now your breast tissue falling off the implants. You will need to have lift and would wait few months before doing the lift.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Overall a good result without a lift

Thank you for your question and photographs.  You should improve somewhat with time, however, what you are unhappy with is due to the sagging that you had to begin with and your result is probably about as good as possible without having a lift. I assume that your surgeon spoke with you about your limitations with an augmentation alone without having a lift.  I probably would have preferred doing a lift along with the implants (probably smaller ones) to give you a more aesthetic result.  In my opinion, in a case such as yours, the improvement in shape that you get with a lift outweighs the scars from the surgery.  You can still get a lift.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Differences before dont change much after....

I make sure and point out all the differences in a woman's breasts during the consultation....This is not to make them feel bad but its to make them aware of these differences. Many women don't notice these subtleties until after surgery because that's when they stare and evaluate their breasts more than they ever have!

I tell my patients that many of these differences will remain after breast augmentation. If one breast is bigger, it will still be bigger (if using same size implants) and if one nipple is lower it will still be lower after augmentation alone. Setting appropriate expectations before surgery is very important.

After your breast augmentation it appears that you have had a good result! If you notice the shape of your breasts, the locations of your nipples etc...it is very likely they are all the way they are because that is the way they looked before surgery. To improve your nipple position and you lower pole fullness a mastopexy may be beneficial, although without evaluating you in person it is difficult to know for sure.

Ankur Mehta MD

Ankur Mehta, MD
Sugar Land Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast shape

You had moderate preoperative ptosis prior to your procedure.  You needed a dual plane augmentation with smooth implants to get more drop and fluff.  I don't think your shape will improve with time.  

Mark A. Schusterman, MD
Houston Plastic Surgeon
4.9 out of 5 stars 77 reviews

Breast shape

Your plastic surgeon did a great job on you and the results that you are seeing are due to the asymmetric droopy and low breast shape that you started with.  Your volume looks good and your shape is reasonable, considering what you had done.  A secondary full mastopexy will imrove your shape and raise your breast mound up on the chest wall at the expense of significant scarring.  

John Dean, MD
Baton Rouge Plastic Surgeon
4.3 out of 5 stars 18 reviews

Volume versus shape

Often implants can help improve the VOLUME of a breast and they do also affect the shape of the breast, soon after surgery and even down the road. Often a mastopexy is used to change the SHAPE of a breast. Sometimes these procedures can be done at the same time and sometimes they are staged, meaning they are done at two different times. Good luck! MMT

Marissa Tenenbaum, MD
Saint Louis Plastic Surgeon
4.5 out of 5 stars 9 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.