Will just a lift help? (Photo)

Since you began at size D, you do not need
implants. Unfortunately, part of your
breast tissue was resected and you had large (371 cc) implants placed. The Wise pattern was performed, which does
not provide significant mechanical support to the implant or to the breast and
the breast bottomed out. I recommend a
new technique called Implant Exchange with Mini Ultimate Breast LiftTM. This technique will reshape your breast
tissue creating upper pole fullness, elevate them higher on the chest wall and
more medial to increase your cleavage.
Aligning the areola, breast tissue and implant over the bony prominence
of the chest wall maximizes anterior projection with a minimal size implant. Small round textured silicone gel implants
placed retro-pectoral look and feel more natural, are more stable, less likely
to ripple or have complications needing revision. Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it. Smaller implants placed higher will give you
the perky C you desired.Best Wishes,Gary Horndeski, M.D.

     The lift will need revision with possible dermal matrix support to produce a more durable result.Try to research this to find the surgeon who consistently produces the
results you would expect. Look at reviews on this site and see who gets the surgery right every time. Find
a board certified plastic surgeon who performs hundreds of breast lifts and breast augmentation revisions each year. Then look at the plastic surgeon's
website before and after photo galleries to get a sense of who can
deliver the results. Kenneth Hughes, MDLos Angeles, CA

A revision can help to reposition things higher.  I agree that using acellular dermis may help, strattice is the most commonly used product and takes the implant weight off the skin acting like an internal bra to support the implant weight.

Dear Nikki,  Thanks for submitting your pictures. From observing your pictures, you indeed appears to be a D cup , your upper pole is flat and the submammary creases are too low, more so on the right side. Also, the right breast is larger than the left one. The reason for your , so called , 'bottoming out'  condition is inability of your tissues to hold the heavy implants or superior capsule contracture that pushed the implants excessively down. The good news is that it can be corrected with the , so called, 'internal bra' . Through a small sub areola incision , the lower crease can be elevated ( lower capsulorrhaphy ) and if necessary the pocket can be enlarged superiorly and medially ( capsulotomy ). All these procedures are done without external incision exept for the entry incision . I would also recommend to reduce the the implants by 1 size if you want to be a C cup. It is important that you consult with board certified plastic surgeons who have lots of experience with 'redo' breast augmentation. Check their before and after 'redo' pictures to make sure that you like the results. Also, make sure that their pictures are numerous and consistent and they have good reviews.                   Best of luck,                                          Dr Widder

Re lifting with or without an ACDM placement (quite costly). Best to obtain a few in person opinions.///

Please find an experienced Board Certified Plastic Surgeon
and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all
aspects of facial surgery, breast augmentation and body procedures including
tummy tucks or mommy makeovers!



In breast augmentation I have chosen to spend time reviewing
photographs with patients to fully understand their expectation of size and
shape. Many times this simply raises
more questions. I will make measurements
and use the implant guides to allow the patient to understand exactly the sizes
that are reasonable for their body type and measurements. Revision surgery can be recommended after an examination of you tissues and review of your implant records.

No a lift will not help, You need internal raising of your infra mammary fold. Excellent result likely but difficult to do.   

Dear Nikki,You sound quite well informed by your question and I think you are on the right track.  You are right about your implants 'bottoming out' and I think that a revision with an exchange for smaller implants is what you need.  You do not need another lift as such, because you do not want your nipples moved any higher, but I think that you would benefit from the skin to be tightened and the inframammary fold raised so that your implants sit higher, which will make your nipples look more centred on the breast (as they did on your early postoperative photo).  This could be done using your existing scarring.  It is usually best to go and see your original surgeon, or failing that, a suitably qualified plastic surgeon in your area.  Good luck.

The problem that you have is what is commonly called "bottoming out."   Your nipples are in a good position--it is the position of the implant that is the problem.   Over time in some patients, the implant can migrate downward causing the nipples to point upward.  The treatment for this problem is to elevate the implant by raising the inframammary fold (IMF).   The pocket that the implant is in extends too low and needs to be elevated.  Recreating the IMF can be difficult and recurrence of bottoming out is not unusual.   Sometimes the fold can be elevated and reinforced with a biological material known as "acellular dermis."  This material is frequently used in breast reconstruction and allows the surgeon to create a sling or internal bra to support the implant.   This material is very effective, but expensive.  Some other materials are also available that are not quite so expensive, including Seri Surgical Scaffold.   You should also consider decreasing the size of your implant to minimize the weight that must be supported by the newly constructed IMF.You should consult with a board certified plastic surgeon who is experienced with revisional breast surgery.  Best wishes!

Unfortunately, what you have experienced is too commonly seen after breast augmentation/lifting surgery. At least part of the “culprit” is the quality of breast skin elasticity.  Patients in your situation often benefit from revisionary breast surgery which may include additional breast lifting, capsulorraphy, and/or the use of acellular dermal matrix. I hope this, and the attached link, helps.