What can be done to help me achieve a more perky appearance after two failed breast augmentations and a capsulectomy? (photos)

Question

Had an explant Oct 2022 and although my breasts are flat and wrinkled up, I haven't been this comfortable in over a decade. I had two breast augmentations and both led to the highest grade of capsular contracture. I'd like to achieve a tightened up version of what I have - smaller is fine. Smaller areolas, open to another breast lift (no more donut lift), no more shriveled raisin under boob or when I bend over. Please help me understand how I can achieve my breast finale. Thank you!

Joel Patrick Maier, MD · Answer

Your best option is fat transfer, especially the left breast. The loss of volume has caused the skin to collapse with loss of the lower pole contour. The right breast has good shape and contour, and could also be enhanced with fat if desired. I would not hesitate to proceed as I think it would be very beneficial to you. Thank you.

Gianfranco Frojo, MD · Answer

I would recommend a new implant placed below the muscle through an incision in the fold. This will lead to the lowest potential chance of recurrent capsular contracture. You may need an areolar reduction (not a donut lift intended for lifting but truly just for areolar reduction). I do not think you need any more "lifting" but definitely need to fill the soft tissue envelope out with a moderately sized implant appropriate for your breast measurements.

Ellen Ozolins, MD · Answer

Thank you for your question. Fat grafting could be a great option for adding natural fullness, but unfortunately, it’s not possible in your case as you appear to have inadequate donor fat. However, you can still achieve a perky, more lifted appearance through a formal breast lift. This procedure can remove excess skin and tighten the tissue, lifting and reshaping your breasts to a more youthful position. Since you’re already comfortable with the size of your breasts, the lift alone can create the perky, tightened look you want without needing to add volume. During a breast lift, smaller areolas can be achieved, and it will give you a better aesthetic outcome and a more proportionate, balanced look. Given your history with capsular contracture and desire to avoid implants, a formal mastopexy without implants is likely your best option. It will lift and reshape your breasts, address the sagging, and tighten the overall appearance without needing volume from fat grafting or implants. This procedure can also reduce scarring using strategic incisions that heal well over time.

Elizabeth Kiwanuka, MD, PhD · Answer

For achieving a tighter and improved breast appearance after explant surgery, fat grafting can be an excellent option. Here’s how it might help:
Fat Grafting Benefits: Fat grafting can help restore volume and improve contour in areas that appear flat or wrinkled after explant. It’s particularly useful for enhancing the overall shape and providing a more natural look.
Combining Techniques: Consider combining fat grafting with a breast lift. A lift can address sagging and reshape the breasts, while fat grafting can add volume and improve the texture of the skin, reducing the "shriveled raisin" appearance.
Smaller Areolas: If you’re interested in reducing the size of your areolas, this can be addressed during the breast lift procedure. Your surgeon can discuss the best approach to achieve your desired look.
Avoiding Donut Lift: If you prefer not to use the donut lift technique, other lift options include the vertical lift or a more traditional anchor lift, which might better suit your needs.
Consultation and Planning: A thorough consultation with a plastic surgeon experienced in fat grafting and breast lifts will help you develop a personalized plan. They can assess your specific situation and recommend the best combination of procedures to achieve your goals.
Understanding these options and discussing them with your surgeon will help you find the best path to achieve your desired breast appearance.

Leila Kasrai, MD, FRCSC · Answer

It’s unfortunate you’ve had such a negative experience. A lift and areola reduction may help you achieve a less “shrivelled”, proportionately contoured appearance. No implants are needed.

Gerald Minniti, MD, FACS · Answer

I'm sorry you had recurrent capsular contracture with your implants, and now have unsatisfactory breast shape. The answer was never a circumareolar mastopexy, as you can see. It does not adequately lift the nipple areolar complex, nor does it reduce areolar diameter. Conversion to a formal mastopexy is the answer to both of those issues. You also have shape, volume, and inframammary fold asymmetry, all of which could be corrected with an implant. In the right hands, your risk for capsular contracture would be about 1%, despite your history. Alternatively, fat grafting might help, but you look like you have inadequate donor site(s), at least based on the appearance of your upper body. If you went the route of fat grafts, I would encourage you to do that as a first and separate procedure prior to the breast lift.

Steve Laverson, MD, FACS · Answer

Many thanks for question with multiple view photos that explain your situation.  There are a variety of possible approaches to improve the breasts.  Consider finding an experienced plastic surgeon in your area to develop a trusting partnership toward breast happiness.  Open communication, an analysis of each asymmetry, irregularity, and aesthetic feature you wish to improve or correct are a foundational beginning.  Goals for breast size, shape, symmetry, scars, areolae, resolution of rippling, and priorities can then be established.  Finally, techniques to achieve your objectives, many of which I believe can be accomplished under local anesthesia in the office.  You appear lean, but hopefully have some fat to transfer into the lower breasts, not to add volume but to smooth contour, improve shape, and fill your existing skin envelope.  Your presentation is complex, and because of your adverse experiences carefully planned steps in the right direction are important.

Michelle Zweifler, MD · Answer

Options for perkier breast include fat grafting and breast lift.  Liposuction is performed from a donor site and fat is placed into the breast.  Early there is swelling with fat grafting and not all of it survives the transfer but is an option for restoring some of the missing volume.  A vertical breast lift also helps tighten up the breast tissue; this could be performed with off-label mesh "internal bra" for additional support and lifting.

Camille Cash, MD · Answer

In order to improve your results you will require another lift.  You have some asymmetry that can be addressed at the time of revision.  The areola can be downsized as well.  See a board certified plastic surgeon near you for a consultation to learn more.

Connie Hiers, MD, FACS · Answer

A vertical lift would help reshape your breasts. I would suggest a fat transfer to the lower scarred breast first to try and achieve more volume in that area.