Would you take on a patient that needs a redo on one side?

Question

I had a reduction and lift 9 months ago. One breast is a full cup size larger than the other and my doctor says that this is within normal range and he doesn't see that it needs more work. I left my appt very tearful because I am more self conscience than I was before surgery. Now my fear is that another surgeon won't take me as a patient to re-do. I am wondering if this is something, in your opinions, that another doctor would take? I hope and pray the answer is yes. I have an appt scheduled.

Kenneth Hughes, MD · Answer

The breasts can be reduced again, and this is not that uncommon. You attempted to work with the plastic surgeon who performed your BR nine months ago, which is the course of action I would have taken. Being unresponsive to your request, you have moved forward by scheduleding an appointment with another plastic surgeon for a second opinion. Go prepared to that consultation with a positive outlook and take your operative records with you. You should be able to find a resolution that is satisfactory.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Larry Lickstein, MD · Answer

While in one sense plastic surgery is about changing anatomy, shapes and sizes, the underlying theme of all plastic surgery (cosmetic and reconstructive) is to bring about changes that make an individual feel better about themselves.  It seems as if this has not been achieved, and judging from your images, the condition could be improved.  I agree with my colleagues, that you should not have a difficult time finding a Board Certified surgeon willing to accept your case.  Best of luck!

Tom J. Pousti, MD · Answer

I'm sorry to hear about your concerns after breast reduction surgery. I do not think that you will have any problem finding a good board certified plastic surgeon to help you. It would be helpful to your chosen plastic surgeon to have a copy of the initial operative report. Once you have chosen your plastic surgeon carefully, it will be important that you communicate your concerns/goals carefully as well.  Working together you will come up with a good plan. Best wishes for an outcome that you will be very pleased with long-term.

Nolan Jaeger, MD · Answer

I'm of the belief that it never hurts to get a second opinion. From a surgical standpoint, a re-do breast reduction is definitely possible. I would recommend consulting with a board certified plastic surgeon (or several) to address your concerns. One caveat is that the purpose of an insurance covered breast reduction is to alleviate symptoms, not provide complete symmetry. A revision for symmetry may be considered cosmetic as some degree of asymmetry after a breast reduction is expected.

Steven Wallach, MD · Answer

If you are unhappy with the size difference, then it is possible to revise it to get it closer......

Emese Kalnoki, MD · Answer

Your result is very nice.  There was some asymmetry before your surgery (your left breast was about 1-2 cup sizes larger than your right breast), and some of that asymmetry persists.  From the photo, nothing was done wrong - your nipples appear healthy and your incisions are healing nicely (it takes at least a year before they finish healing and become a white line).  If you would like more tissue removed, then I would recommend a combination procedure of liposuction to the breasts with a conservative reduction.  The blood supply to the nipple and areola can be placed in jeopardy for a "re-do" breast reduction and that is why a number of plastic surgeons would hesitate to return to the OR.  Take things slowly - allow for complete healing. After that, if you are still concerned, then revisit your plastic surgeon (who knows the procedure that he or she did and knows the blood supply that was left for the nipple), or visit another plastic surgeon.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. Regardless of your asymmetry, I think you are a reasonable candidate for a revision. Of course, you will need an in-person consultation to evaluate you for this procedure. Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck!
 
 Best,
  
Jon Ver Halen, MD FACS 
 Harvard educated plastic surgeon

Michael Carlisle, MD - Account Suspended · Answer

I have certainly done reduction/lifts successfully on re-do patients like yourself. It would require an in-person exam and discussion, plus bring the operative report of your first reduction to your consultation. 9 months should be fine in terms of time-line. All the best

Marc J. Salzman, MD, FACS (retired) · Answer

From your photograph, I would think that both breasts could be improved with evening out of the volume and moving them a little higher on the chest wall. Even if only one breast needs a touch up, that does not dissuade me from offering you surgery. Each plastic surgeon may have their own thoughts on the subject. Best of luck.

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