Will I need another revision?

Question

I got a breast augmentation, over the muscle gummy bear implants March 2023. I love the way left breast came out but the other one seemed to be lower always seemed to be lower and the scar was higher too. My Dr suggested opening the imf incision and stitching the pocket higher and opening the pocket more on top. It has been 12 days and I’m wondering if drop nd fluff will be enough to even everything out. The new imf incision seems really high. I saw my Dr,he said to use compression. Thoughts?

Jeremy Bosworth, MD · Answer

Hi! It sounds like what your surgeon did was probably an acceptable plan. I dont know if you had some asymmetries prior to the original surgery, but most people do, even the most perfect breasts. I think being only 12 days after the revision it is too early to really even consider how things are looking because they will definitely relax and it may be enough for them to be closer. This can be one of the hardest times of the recovery but it really is a waiting game at this point. Try to just focus on healing/ recovery and following all of your surgeons instructions and id wait at least 3 months before even considering how they are looking. Hang in there!

Connie Hiers, MD, FACS · Answer

Your doctor is right. the inferior pocket is too low and needs to be tighten. If your implants are textured, they will not drop.

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment regarding the outcome of any plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you’ve had more than one procedure, then you should include before and after pictures for each of the previous procedures.
without seeing what you look like before your augmentation we can’t make a good assessment regarding your candidacy for the procedure in the first place.
Based on the pictures included, I think your right breast looked fine and I don’t see the need for the revision.
 Without seeing what you look like before your augmentation, we can’t make a good assessment regarding your candidacy for the procedure in the first place.
Based on the pictures included, I think you’re right breast looked fine and I don’t see the need for the revision.
I’m guessing you had significant breast symmetry before your first operation.
It’s common for the left breast to sit higher on the chest wall than the right side.
This is true for almost all people.
The IMF on the left is typically 1/2 inch higher than on the right.
Breast augmentation outcomes are typically based on three variables.
The first is the patient’s candidacy for the procedure.
Variables that alter candidacy include breast asymmetry, breast ptosis, breast, divergence, or breast sitting far apart on the chest wall.
The second variable is implant choice in regards to size shape, and type.
Working with excessively large implants, increases the chance of undesirable outcomes, complication rates, and the need for revision surgery.
Using implants that are significantly larger than your natural breast diameter causes increased complication rates.
The third variable is the surgeons ability to place the implant in the correct anatomic location during surgery.
The ability to accurately place implants correctly is highly varied by implant choice, especially the decision to use implants that are significantly larger than the breast itself.
I don’t really think your right breast had bottomed out.
It doesI don’t really think you’re right breast had bottomed out.
It doesn’t look like it in the picture.
It looks like you have a well distributed amount of volume above and below the nipple areola complex. 
If the natural IMF has been violated through breast, augmentation surgery, things become complicated and more difficult.
Correcting bottomed out implants is inherently difficult and is always a balancing act between over and under treating.
Because I don’t see clear evidence of your implant bottoming Out I’m not sure that the revision was totally indicated.
 we can’t make quality assessments without quality information and this means having access to proper before and after pictures from both of your procedures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Either follow up with your provider or schedule in person second opinion, consultations with other plastic surgeons in your community.
For second opinion, consultations come prepared bringing with you a complete set of before and after pictures and copies of both operative reports.
It looks like you have significant breast divergence and asymmetry as baseline. 
Some of the issues I think are related to your candidacy for the procedure in the first place.
Some of the issues are related to the implant size.
Some of the issues are related to how the procedure was done.
My personal preference is generally subpectoral implant placement for breast augmentation surgery.
An assessment is going to be limited based on the information we have access to.
Selecting modest size implants tends to lower the need for revision surgery.
Best,
Mats Hagstrom, MD

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