4th revision - Best surgical approach to fix waterfall effect, scarring and asymmetry? (photo)

Question

Hello everyone! I’ve been struggling with my breasts for 9 years, and I would truly appreciate your insights! I’m a 28-year-old healthy woman, but my self-esteem has taken a huge hit due to repeated surgeries with disappointing results. I had severe ptosis my entire life, so in 2016, I underwent a mastopexy with subglandular implants. Soon after, my left breast started to look boxy, so my surgeon performed a revision in 2017, lowering both nipples to improve proportions—but only by reducing the skin, not adjusting the implant pocket. A year later, my left breast still looked boxy and lacked an underboob curve, so I had another mastopexy. Over time, my left breast started to lose its shape again, and I finally realized I had been experiencing bottoming out this entire time. In 2022, my surgeon performed yet another mastopexy, this time moving my implants from over the muscle to under the muscle. Unfortunately, the results are worse than ever: Neither breast has a proper underboob curve, they don't look natural, my right breast looks too high, I have a waterfall effect and double scars. I am now considering a 4th revision with a new surgeon, but I want to make the most informed decision possible. What would be the best surgical approach to fix this? Can I replace the implant back to subglandular position? Has anyone had success correcting a case like mine? Any advice would mean the world to me. Thank you so much for your time and expertise!

Daniel Barrett, MD · Answer

Dear Original787943,

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

Gary M. Horndeski, MD · Answer

You have had 3 previous breast surgeries with unsuccessful results. At this time, the most concerning aspect is the scarring. You can certainly undergo a scar revision to improve the appearance of the scars. I would leave the implant alone but change the position. You are better off with implants behind the muscle.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

I would keep the implants behind the muscle for better support. You have already bottomed out with the implants in front and may do so again unless you go smaller. Your pockets can be adjusted so that the implants are settled better. Find a good revision surgeon.

Hilton Becker, MD · Answer

I would place the implants above the muscle under the fascia with mesh support.
Elevate the infra mammary fold which may be difficult to do in your case due to the scarring.
Another option would be to remove the implants and start from scratch 3 mths later

4th revision - Best surgical approach to fix waterfall effect, scarring and asymmetry? (photo)

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