I'm 2 mos. post-op from a vertical mastopexy. I feel that my breasts look very bizarre. My nipples point in an upward direction and are placed too high on the breast. Also, my right breast is assymetrically shaped in comparison to the left one. I voiced my concerns to the Dr. at my 3 wk post-op visit. He brushed them aside and said that the nipples had been correctly placed and that the right breast was just larger. Did something go wrong with the mastopexy and if so, can things be fixed?
Mastopexy Gone Wrong?
Doctor Answers 12
You were not a good candidate for vertical lift in the first place.
If your nipples are somewhere near 21cm from the sternal notch, they are not "too high." Your residual breast tissue is simply "too low," which could be described as "bottoming out." Your skin brassiere needed shortening in horizontal AND vertical dimensions, whereas a vertical, lollipop, or circumvertical lift accomplishes skin tightening in only one direction. Often a vertical lift is"sold" to patients on the basis of "avoiding the inframammary scar," but this is a scar that usually is hidden in the crease and heals well in the majority of women. It was necessary to achieve proper skin tailoring for your breast anatomy.
Sure, some patients can develop hypertrophic (thick, overgrown, or wide) scarring, and some surgeons still have technical difficulty with the inverted-T junction of the breast flaps and their patients develop wound breakdown or ischemic healing problems. These are largely avoidable by proper patient selection, avoiding operations on smokers, and learning the proper surgical techniques--NOT by trying an entirely different operative approach (vertical lift) on every or most patients.
This result occurred because your surgeon chose to perform a vertical lift when he should have performed a full Wise-pattern ("anchor") mastopexy. Surgeons choose their breast reduction techniques on the basis of training, experience, or habit, and unfortunately, not every patient is a candidate for a vertical mastopexy. Of course, it is easy after the fact to make this assertion, and I'm certain your surgeon felt he was making the best choice at the time. It didn't work out, and every surgeon should discuss with their patient BEFORE surgery what the re-do or touch-up policy is when things don't turn out as (both of you) expected.
If your surgeon is defensive and thinks this is as good as it gets, you will need to find another surgeon and undergo revisionary surgery, which can give you substantially better results. A patient of mine who had a similar situation can be found by clicking on the web reference link below. Best wishes! Dr. Tholen
Bottoming out after a breast lift
Symmetry is the curse of plastic surgery and even though the same operation is done on both sides they frequently heal like they are on two different people. You appear to have some nice improvement as you progress and it is possible that this will continue. You are at the 10 month period and it may be time for a reassessment and possible revision to center the nipple over the implant and revise the mastopexy. Possibly converting to a vertical type with a shortening of the inframammary segment. You may need a IMF incision as well.
Breast Lifting Revision?
Thank you for the question and pictures.
I agree with your assessment. your results can be significantly improved with revisionary surgery. This will likely involve removal of additional skin as well as breast implants repositioning.
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Breast lift asymmetry
The good news is that your results can be improved/corrected with a relatively straighforward revision. When patients have significant pre operative asymmetry as well as a significant need for a lift I usually discuss the possibility that a revision may be needed to achieve perfect symmetry.
All the best,
Dr Remus Repta
Mastopexy gone wrong
Your vertical mastopexy can be "fixed"
I believe your situation can be improved by converting to a full anchor- shaped or Wise pattern mastopexy.This way the breast mound can be supported from below so that the nipple sits in a centered position. Also some breast tissue can be removed from the larger breast for symmetry. I hope you surgeon will help you with this.
Nipple too high after breast lift
It is possible to place the nipple too high with a vertical breast lift or reduction. The breast will appear full and bottomed out, what was called a 'virginal tilt' to the nipple which pointed upward after reduction many years ago before we knew better. Your result can be improved by reducing the skin envelope under the breast, converting the skin pattern to a 'T' which will help pull the nipple down, front and center on the breast. So good news, there is a solution and you can look much better.
Best of luck,
When is a "vertical mastopexy" not enough?
In my opinion, the choice of a vertical mastopexy in your case was not what I would have advised because you had too much extra skin and laxity to go with less than a full T incision pattern. You can still salvage this by going back and doing a crease incision and taking out more lower pole skin and tissue and this will also pull the nipples down a bit.
There are surgeons who believe you can do all reductions and lifts with just a vertical scar but I think your case nicely demonstrates that this just isn't the case and that there will always be a role for a well performed fullT incision lift or reduction. Good luck to you.
Nipple placement during breast lift and reduction surgery
Your nipples do appear to be high relative to the upper border of your breast. This can be a challenging problem to fix. You appear to have a long areolar to infra-mammary fold distance as well. These problems can be addressed by removing a transverse 'wedge' of breast tissue along the fold beneath your breasts, thus shortening the areolar to fold distance. This will also get rid of some of the sagging tissue you have along the lower pole of each breast. This solution is not perfect, but it will help the situation to some degree.