Atrophy/depression gland one year after implant and mastopexy - can this be fixed with filler or fat grafting? (Photos)

Question

My breasts used to be fairly large, around a 32C bra size. After pregnancy and breastfeeding, they became significantly larger and developed striae (stretch marks). Once I stopped breastfeeding, the breast glands atrophied and my breasts became severely ptotic (sagging). After my second child and after finishing breastfeeding, I underwent mastopexy with implants. I received Mentor MemoryGel 285cc High Extra Profile implants, along with fat grafting and internal bra fixation using suturing techniques. Initially, the results looked very good and round. However, a few months later, my left breast developed a depression in the middle area between the areola and the inframammary fold, exactly along the mastopexy scar line. Around 1–2 months ago, my right breast also started to develop a similar depression. Could this be due to atrophy in the sutured area causing poor vascular supply and glandular atrophy, or could it be from fat graft resorption? Or perhaps traction from scar tissue/fibrosis? It has now been 1 year since the surgery. Would filler treatment be sufficient, or would repeat fat grafting be necessary? I would prefer to avoid another surgical procedure if possible.

John LoMonaco, MD, FACS · Answer

I see the "dip" and agree it could be any of the issues you mention: I'd llean towards scar adherence and fat resorption if that area was grafted.  Fat graft loss can cause scar tissue by the way.  Severa treatments are available, and all carry some risk of making things worse or failing to correct the issue.  If the "dent" is a serious concern for you, a procedure makes more sense.

Semih Yildiz, MD, FEPOBRAS · Answer

From your description and photos, this type of indentation can come from a few different things: scar tethering along the mastopexy line, thinning or atrophy of the overlying breast tissue, fat graft resorption, or tension from deeper sutures/internal support. It is usually not possible to identify the exact cause from photos alone, so an in-person exam by your plastic surgeon is important, especially since implants are present.

In the breast, injectable filler is generally not my first choice for this type of contour problem. Fillers can create lumps, may interfere with breast imaging, and often do not release a scar that is pulling the skin inward. If the area is tethered, the scar usually needs to be released first, either with a minor revision/subcision-type procedure or a more formal scar release, and then fat grafting can be used to soften the contour.

Repeat fat grafting is often a better option than filler for a stable contour depression, but it may need to be staged because some of the transferred fat can resorb. I would also ask your surgeon whether any imaging, such as ultrasound, is needed before revision to check the implant pocket and soft tissue. If there is increasing redness, drainage, new pain, or rapid change, you should be examined promptly.

Atrophy/depression gland one year after implant and mastopexy - can this be fixed with filler or fat grafting? (Photos)

Answers (2)

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