5’2, 28F, 3 BA surgeries: should I have a lift and move the implants to subglandular for a more natural appearance? (Photo)

Question

March 2021: breast fat transfer, infection in right breast causing asymmetry. December 2021: under muscle BA, high profile mentor, 400,475 December 2022: revision to go smaller under the muscle BA, mod profile xtra plus mentor 325, 375 My left bigger breast is saggy and right has a hump appearance. Been to three doctors with all different opinions. Latest one wants to change to subglandular, repair muscles, lift both and lipo the bigger one. Do you agree? What would you do in my Case?

J. Timothy Katzen, MD, FACS · Answer

Hi Montreal21,

I appreciate your inquiry about whether to proceed with a breast lift and reposition your breast implants to a subglandular position for a more natural look. Your history and the provided pictures have been very helpful in assessing your situation.

In cases like yours, the consensus among most plastic surgeons, including myself, is to favor moving the implants to a subglandular position. This change could potentially provide a more natural appearance and feel to your breasts. The necessity of repairing your pectoralis muscles will depend on various factors, including the condition of the muscles and your specific aesthetic goals.

Regarding the breast lift, if you choose to retain your current implants or opt for smaller ones, a breast lift would likely be beneficial. The type of lift - whether it's a doughnut, lollipop, or vertical mastopexy - will largely depend on the size of the implants you select and the degree of lift required. Going for significantly smaller implants would necessitate a more extensive lift.

When it comes to achieving symmetry and reshaping, physically removing breast tissue surgically tends to provide more precise and predictable results compared to liposuction. This approach would be key in addressing any asymmetry you are experiencing.

I hope this response clarifies your options and assists you in making an informed decision regarding the lift and repositioning of your implants to achieve a more natural breast appearance. Remember, the final decision should align with your personal aesthetic goals and physical considerations.

Wishing you the best in your journey towards achieving the look you desire.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Gary M. Horndeski, MD · Answer

If you are dissatisfied with the volume of your breasts then I recommend smaller implants instead of liposuction. Also, I would not recommend subglandular as this would lead to higher risk of capsular contracture. If you want to change the position of the nipple-areola complex then you can use a circumareola approach to reposition them and correct the asymmetry.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

You have many options. From
My standpoint I would not go with larger implants. Implant size is not your problem

Connie Hiers, MD, FACS · Answer

With a lift, I recommend staying under the muscle for better support. Otherwise, your once sagging breast must now support all the weight of the implant and is at higher risk of sagging again. I do think your implants should go down in profile, and I suspect your implants may still be sitting a little high and need to be released to drop down more.  I also think a smaller implant, perhaps something like 275 and 325 or 300, will fit your tissue and frame better.

Ralph M. Rosato, MD · Answer

Your implants are very large for your frame. The pockets do not match and putting the implants on top of the muscle and muscle repair in a singele operation will most likely not correct your asymmetry. I would remove the implants and scar tissue, allowing your body to heal.  Then consider a new augmentation based on what the surgeon found at the time of surgery.

Mats Hagstrom, MD (license on probation) · Answer

Your situation is complex and probably be on what is appropriate for quality advice by posting on this website. To make an accurate assessment on the outcome of a plastic surgery procedure. We generally need to see quality proper before and after pictures. If someone has had more than one operation. Then we should ideally have access to before, and after pictures for each of the previous surgeries. When you getting a quality, second opinion consultation, you should come prepared to bringing with you before and after pictures for each of your previous procedures, and operate reports for each of the previous operations. 
Quality outcomes are based on having a clear understanding of what the underlying problem or ideology is.
Until someone can explain to you why your breast look the way they do they’re probably not in a position to attempt to make things better. Converting implant position is sometimes ideal but it’s usually more commonly done from above the muscle to below the muscle. If there’s nothing wrong with the implant pocket, then implant position shouldn’t need to be changed. Your breasts look quite large and working with excessively large implants increases undesirable, side effects, and complications.
Finding the best provider is not always easy or straightforward. Revision work is many times more difficult and complex than primary surgery. Considering how many previous operations you’ve had the chance of having a quality outcome is not in your favor.
The importance of provider selection cannot be overstated. This becomes of greater importance, the more difficult the situation becomes.
Sufficiently talented provider should understand the complexity and difficulty of the task at hand. They should also have hundreds of before and after pictures and be able to show you numerous previous revision cases of other patients with complex situation’s, they have restored successfully.
There’s no correct number of consultations needed to find the best provider. I generally recommend patients consider having at least five consultations before choosing a plastic surgeon.Generally speaking an experienced plastic surgeon and should have no difficulty showing you the before and after pictures of at least 50 previous patients for any commonly performed procedure.
Once normal anatomy has been distorted based on a poorly done previous surgery restoring outcomes to quality results becomes very difficult
Best,
Mats Hagstrom, MD

5’2, 28F, 3 BA surgeries: should I have a lift and move the implants to subglandular for a more natural appearance? (Photo)

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