Bottom of breasts look “pulled down” and sit to the side, lack of upper pole - do I need to replace the implants? (Photos)

Dear emmayd1,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.


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

From your photographs, it is impossible to get a good idea of the relationship of all the landmarks to each other. Many more photographs and certainly an examination would help. It seems you may have a very nice result and revisions can sometimes be very complicated. In certain situations, it is best to enjoy your results. Some years down the road, things may soften and a revision might be a much more worthwhile venture.

You will need a complete revision of your reverse tummy tuck. This is not uncommon to happen when an insufficient number of progressive tension sutures were used. In addition, both of your implants have lost there original position due to pocket expansion, most likely exacerbated by the loss of inframammary fold position. Capsule tightening with mesh will help re-establish proper implant position. A minor adjustment to the breast lift flaps on one breast will also help with symmetry.

Based off your photos and the comparison photo - yes, does appear that the reverse TT incision pulled down the IMFs of the breast resulting in the pulled look. Likely need to rebuild the IMFs again - maybe with mesh to help with support and I agree, change the implants for higher profile to give more cleavage and upper pole fullness (or you can +/- fat graft your cleavage or upper pole area as well) Definitely worth revisiting your surgeon(s) for possible revising the IMFs and seeking out their plans, but I would recommend asking about internal bra mesh to help lock in the IMFs so the pulling is way less likely to happen.

The implants are not the major problem. The problem is that the skin of the upside down tummy tuck is attached to the breast skin and is pulling down. You need to separate the two. What I recommend is using an inframammary incision to remove the outer layer of dermis. The inner layer of dermis is still attached and is intact to the underlying fascia or ribs, pulling the tummy tuck up higher and allowing the breasts to sit independently of the tummy tuck scar.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question. I have been in practice for over 30 years, and breast revision surgery is a large portion of my practice. You would benefit from changing to an ultrahigh profile implant and a capsulorrhaphy/internal bra procedure. That would give you more projection, more fullness on the top, and a more round, narrow appearing breast. You should be able to have an excellent result. Best wishes to you.

Thank you for sharing your concerns and photos: It’s clear you’ve done your research and are seeking thoughtful, long-term solutions.
From your description and images, it appears that the main issues are implant malposition with descent of the lower pole and a lack of upper pole fullness. This can sometimes occur over time, especially with low-profile implants and soft tissue changes after combined body contouring procedures.
A full implant exchange may not be absolutely necessary. In many cases like yours, a more conservative and effective approach can involve:
✅ Fat grafting to the upper pole to restore volume and improve contour✅ Elevation of the inframammary fold and lower breast scar, which helps reposition the implant footprint and support the lower pole more naturally
These techniques can significantly enhance the overall shape and symmetry without requiring a full implant replacement, especially if you’re still happy with the implant size and feel.
A detailed in-person evaluation is key, but based on what you’ve shared, your surgeon’s suggestion of a revision lift, combined with these refinements, sounds very reasonable.
Wishing you the best on your revision journey!
Warm regards,M. Mustafa Aydınol, MDPlastic, Reconstructive & Aesthetic SurgeryIstanbul, Türkiye

Currently you have a very nice result after abdominoplasty. However, occasionally due to gravity, upper abdominoplasty scar/insertion is pulled down and stretches the lower pole of the breast. It is quite possible that happened in your case. You may discuss with your surgeon “lift” of IMF incision, stable fixation to the ribs and placement of more projected moderate or moderate plus implants. It can all be done using already existing scar. Good luck.

Thank you for your question. An honest discussion with your surgeon is the best first step to addressing your concerns. Although there are a few photos, it is difficult to ascertain completely without a physical examination. The reverse tummy tuck can pull down the original IMF, which can result in a pulled-down appearance of the breasts. Revision surgery can help correct this, as will switching to a higher-profile implant. Good luck on your journey!

From the submitted photos it appears the reverse tummy tuck pulled the inframammary folds down and created the look you have now. A revision would be needed to correct this. You can consider exchanging the implants for a higher profile to improve shape as well.