Square breast after lift - can this be fixed under local anesthesia? (Photos)

Question

Nine months after my breast lift, I am not happy with the results. The breast looks very square too much skin left on the side. Is this an adjustment that can be made in the office under our local anesthesia?

Daniel Barrett, MD · Answer

Dear Gigijojo,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donovan Rosas, MD · Answer

What can or cannot be accomplished under local anesthesia is a function of patient and practitioner comfort.

If the operating surgeon is confident that the goals can be accomplished expeditiously and safely while keeping the patient comfortable...then a procedure can be performed under local.

With regards to your specific question, it is difficult to say with any certainty as to whether I would be comfortable undertaking a revision under local without an in person exam. A small revision is easier to accomplish than a larger undertaking.

Based on the limited photos, you may benefit from re-excision of the lower pole/transverse limb (as this appears lengthened).

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Wayne I. Yamahata, MD · Answer

Most minor breast revisions can be done under local anesthesia with light sedation. More extensive procedures may require heavier, monitored anesthesia or general anesthesia. These options can be discussed with your surgeon.

Roxanne Sylora, MD · Answer

To improve your result, it depends on 1) how much your pain tolerance is and 2) how your procedure was done.  Local anesthesia hurts when injected, and the more that has to be numbed, the longer you will feel some of this.  So part of the answer depends on you, your anxiety level, \and how much you want to remember about sounds and smells during a revision.
Without seeing you in person (photos only tell part of the story) the fix could be relatively simple or could be more complicated.  The nipple position looks high but it could be that you have too much skin at the bottom.  Complicated fixes would be more difficult to tolerate under local anesthesia.

Emre Guvercin, MD, FEBOPRAS · Answer

Hi there &mdash; thank you for sharing your photos and concerns. A “square” breast shape after a lift is usually caused by excess lateral skin or insufficient tapering of the lower pole. The good news is that this type of contour issue can absolutely be improved.
If you are happy with your current projection:
A simple Wise-pattern skin excision (removing the extra lateral skin and re-shaping the lower pole) is usually enough.This can often be performed under local anesthesia in the office, with a relatively quick recovery.
If you want more upper-pole fullness or projection:
In that case, a more structural correction is needed &mdash; typically a Preservé technique or traditional subfascial breast augmentation+ skin excision, which can also be done under local anesthesia. This reshapes the internal support and creates a rounder, perkier contour instead of the square shape.
The bottom line:
✔ Yes &mdash; the issue is fixable.✔ Yes &mdash; in many cases it can be done under local anesthesia.✔ The exact approach depends on whether you want more projection or are satisfied with your current size/shape.
You’re still within the revision window, and these adjustments tend to heal very well.

Tyler Frew, MD · Answer

Hi there,
Yes, that type of adjustment can be done under local and or light sedation. It will increase the length of the scar underneath your breasts. I can’t tell from the photos if you had a lollipop or anchor style lift but you will need to add or extend the anchor scar for more skin removal and better breast shape overall. 
All the best

Ryan Endress, MD · Answer

It appears that your nipple to IMF distance has stretched, yielding this flat appearance without projection. This can be addressed with local anesthetic to reshape the breast and achieve a more balance and less flat look, with or without adding volume with fat/alloclae injection. It mostly depends on how tolerant and comfortable you are with local anesthetic and laying still for the duration of the case. With an ultrasound guided pec block it is even easier to tolerate, although this would still be performed in the operating room given the extent of the revision. With our own operating rooms this cost can be controlled, so for those that work out of other surgery centers the cost of revision must be considered. Thanks and hope this provides some insight!

Camille Cash, MD · Answer

From the submitted photos it does appear you would benefit from a revision to your lift.  It would address and improve the overall shape, particularly the lower portion of the breast.  For the best result a trip to the OR for optimal correction would be advised.

Sean Fisher, MD · Answer

It is difficult to say what exactly needs to be done to correct your concerns, based on the provided photos. In nearly all instances in my practice, I perform breast surgery under general anesthesia. There are exceptions to this such as small scar adjustments etc. However, if you are hoping to correct the overall shape of your breasts, this likely means a full revision with elevation of the breast skin and reshaping the breast tissue. This often requires intra-operative trial adjustments and placing patients in a seated position to ensure improved shape/symmetry. In theses instances, a general anesthetic is safest. 
Sean Fisher, MD Aesthetic Plastic SurgeonSeattle, WA

Darryl J. Blinski, MD · Answer

Based on your post photos, you need to complete redo of the lift with an extension into the axilla. This cannot be done under local anesthesia. It needs to be under a light general anesthesia expect fees to range from $5000-$10,000. Best of virtual consult with for better understanding.

Square breast after lift - can this be fixed under local anesthesia? (Photos)

Answers (10)

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