What revision surgery would you recommend to correct sagging mastopexy with implants? (photos)

I am 8 months post submuscular mastopexy with implants and am unhappy with the results as they have dropped considerably. My surgeon has agreed that revision surgery is required free of charge and I am having this done in January. He wants to make one incision without opening the full anchor scar and put in bigger implants whilst taking more skin away from the bottom. My question is wont bigger implants make them even droopier?? Surely I should be having smaller implants this time??

Doctor Answers 9

Droopiness after implants and a lift

Thank you for your question. The fact that one doctor answered this saying you have a good result should emphasize the need to always get a second opinion. What you have is an average result which is what the average plastic surgeon would accept as adiquate. It is only adequate if the patient is happy with the result. If you compare the two pictures of where you were before any surgery and where you are now you will see that the breast have settle into the exact location. That is not acceptable. I agree with your surgeon that revision is needed. But you have several options but all options should include a capsulorrhaphy (or aka the internal bra procedure). So here is how you decide.

1) if in a tight bra you like the size then the doctor should perform a capsulorrhaphy but can increase the size of the implant but the increase is only equal to the new tissue volume he takes away. So that over all you end up the same size but with a much better result.

2) if you ok being slightly bigger then do the above but add as much volume as needed to achieve the cleavage and upper fullness you desire.

Best of luck. But don't settle for average results when there is much room for improving this.

Birmingham Plastic Surgeon
4.8 out of 5 stars 319 reviews

Unhappy after BL surgery

I am so sorry to hear you are unhappy with your results.  Judging by your photos, I would recommend re-doing the full lift to re-tighten the skin that has stretched that began to drop a bit from the weight of the implant.  Without doing this and putting in a larger implant the skin may began to sag more.  However, I would just consult with a few more doctors so they can physical evaluate  you in person as well.

Leonard Hochstein, MD
Miami Plastic Surgeon
4.4 out of 5 stars 203 reviews

Consider internal bra for revision augmentation mastopexy

Augmentation mastopexy has a higher rate of revisions because it is hard to predict the long-term result after healing and settling. consider that the reason for the lift in the first place is because the tissues have stretched and sagged; add the weight of an implant, and there will often be settling as you have experienced. Larger implants will put more stress on the tissues. An internal bra with Galaflex or Strattice will offload the weight of the implants from the skin envelope.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Failed breast lift with augmentation

You are correct. A larger implant will undoubtedly stretch you back out again or cause other problems (chronic pain, nipple numbness, irreversible soft tissue damage, skin stretch deformities, capsular contracture, etc.). I have spent many years developing a way to lift breasts without using the vertical scar techniques (which by the way weakens the skin envelope at the point of maximum tension) and using a woman's own tissue to re build it and achieve perky/youthful natural results that are long lasting. I have attached a short video showcasing how I achieve this. No implants were used and no ugly vertical scar. In my hands, if you were set on keeping implants, I would switch them for smaller ones, reinforce your capsules and remove any excess skin. However, you do have another choice, and that is to remove your implants completely and perform my technique on you using your own breast tissue. Hopefully, your previous surgeon didn't remove much breast tissue so I can have some to work with. I hope this helps. Best wishes and kind regards, 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

What revision surgery would you recommend to correct sagging mastopexy with implants?

I am sorry to hear about your concerns after breast augmentation/lifting surgery.  Adjustment of the breast implant capsules (capsulorraphy) along with additional tightening of the breast skin envelope (revision of the mastopexy) will likely be  necessary to improve your outcome.  Breast implant size selection will likely be made after consideration of concerns such as risk of recurrent implant displacement along with what would size/profile of breast implants would be necessary to achieve your aesthetic goals.  Best to communicate these goals with the help of photographs. Best wishes for an outcome that you will be very pleased with.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast Implant Settling after Augmentation

This is a common issue after augmentation and is in the same spectrum as breast implant bottoming out.  If you have a transverse or horizontal scar as part of your mastopexy, then I would use this to perform a capsulorrhaphy which uses the scar tissue envelope around the implant to support and lift the implant back to a normal position.  Smaller implants would also need a capsule reduction and potentially a lift of the nipple and the crease of the breast to create the look that you want.  Our clinic is close to where you live.  I suggest you seek a second opinion before January.

Christopher J. Schaffer, MD
Birmingham Plastic Surgeon
4.8 out of 5 stars 115 reviews

Redo breasts augmentation

Dear E,

    Thanks for submitting your before and after pictures pictures and sorry for your unhappiness with the outcome of surgery.

   Your breasts appear quite low on your chest. It is important to know if you developed superior capsule contracture  that pushed the implants downward. 

   Your surgeon's plan does not make sense to me, because he does not address the problem. Moreover, bigger implants and cutting skin at the bottom will  worsen the situation. Getting a second opinion might be very wise and in your best interest.

   If you were my patient I would have recommended the followings:

   1. Superior Capsulotomy (scar release) , to allow the implants to move into higher position.

   2. Inferior capsulorrhaphy ( internal bra ), which will raise the pocket and keep the implants in higher position. You will have to wear a bra with wire 24/7 (except for shower) for 6 weeks for support and allowing the new fold's scar to become strong.

   3. Mini lift ( donut, Benneli ) to compensate for the higher implants and maintaining perky breasts.

        I hope this helps,

                          All the best,

                                       Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 124 reviews

Revision will be necessary to achieve your goals, which sound achievable...

Hi there,

Based on your question and the photos you posted, I don't see any reason why achieving your goals would not be possible if the details of the procedure performed are planned and executed carefully and you follow all postoperative instructions with the same care.

The details of how I would personally approach this situation would depend on the careful discussion and examination we would have prior to proceeding. Similarly, it is difficult (and would be irresponsible of me) to say whether or not I agree with the proposed revision your surgeon is offering without the benefit of this consultation and exam... I do think that getting another opinion is worthwhile if you are unhappy, but you really should do this in person for the opinion to be meaningful. Even the very best surgeons would not be able to give good advice without an exam and more detailed discussion.

The good news is that I think that what you want is possible. The bad news is that to learn more about how/when/why (from any particular surgeon), you need to visit in person.

Good luck!

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Realistic expectationa

Thank you for your question. You appear to have a very good result. It seems that the real problem here might be that you were not given realistic expectations from your surgeon up front. For you to expect your breasts to maintain the same appearance they had at 6 weeks following surgery is not realistic for someone with the same preop size and shape as you. Before you undergo another surgery, I suggest you speak more in depth with your surgeon about what the likely result will be. I believe you are correct in that larger implants will give a more droopy appearance, especially over time. 

Nicholas Tarola, MD
Nashville Plastic Surgeon
4.9 out of 5 stars 58 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.