Do my Breast Look Right? (photo)

I had a lift and augmentation with small saline gel implants (265cc) six months ago. I got the implants to ensure volume and roundness. My right implant is not dropping, hasn't moved at all. My left was okay for a while, but now I have noticeable tissue below the implant. With both breast implants the bottom of the implant is at nipple line. When viewed from the side, my breast appear to be flat. I really like my surgeon, so would never go elsewhere, but is this just anatomy or surgeon error?

Doctor Answers 7

Do my Breasts Look Right after Breast Augmentation/Lifting Surgery?

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Thank you for the question and pictures. Your pictures clearly demonstrate the concerns that you mentioned in your description.  You're less than  optimal outcome is not necessarily due to your “anatomy” or “surgeon error”.
Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.

Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time.  This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation.

Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery.

On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  

The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air, while at the same time removing some of the balloons rubber surface.  I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.

To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of the goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.

Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery.

 At some point, communicate your concerns with your plastic surgeon;  hopefully, working together, you can develop a plan to improve your outcome.

 Best wishes.

Correction of pesudoglandular ptosis

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You have pseudoglandular ptosis meaning that the breasts, even though you had a lift, still are falling off of your subpectoral implant.  To correct this problem you need an inferior release of the muscle and capsule as well as a revision of the vertical scar and possibly more elevation of the nipple so that it is centered over the center of the implant.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast implant disconnect

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Your breast looks OK as far as the lift goes yet your implants our bet are under the muscle and you have a 'pectoral' augmentation rather than a breast augmentation as the implant is above and the breast tissue below, a disconnection between the two. A solution is a more complete release of the muscle to allow the implant to center itself in the breast, or place the small implant in a subglandular position so there is a better marriage between the implant and breast proper.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast augmentation and mastopexy done together

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can certainly be challenging to hit the 'grand slam'.  My patients know revisions are likely and they can certainly improve results.  The most important thing is to get your implants level with each other as implant revisions usually require going back to the OR.  If your implants are in good position, then the soft tissue revisions can be done in the office under local.  Your results are not perfect but very few results fall into that category and are more a result of luck rather than surgeon skill.  Keep your surgeon informed of your concerns and if a conscientious one, he/she will help you achieve the result that both of you desire.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Do my breast look right?

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Thanks for your photos.  It looks like both implants are high and the rest of the breast has flopped off of the implant.  i.e. the implant and breast do not move as one.  This may be related to one of two things.  inadequate release of the medial pectoralis muscle which prevents the implants from settling or dropping or the second is formation of a lower pole capsule which also prevents the breast implants from dropping.  If you flex your pectoralis muscle and the implants move up or gets pushed off to the side then the pectoralis muscle was not adequately released.  The flat look is related to the implants sitting too high and inadequate skin removal.  It looks like your breasts are still saggy i.e. the implants do not have enough volume to fill the skin envelope or the skin envelope is too big. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 107 reviews

Do My Breast Look Right?

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Since it's been 6 months since your surgery, you should discuss a possible pocket revision with your doctor.  There is no way to predict how a patient will heal.  You did not say if you did breast exercises, or have regular follow up visits with your surgeon.  These are important issues in regards to healing from surgery.  Best wishes!

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Do my Breast Look Right?

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Thank you for your question and for the attached photos. A couple of things would make it more helpful in offering suggestions:

  1. pre-op photos
  2. post op photos with arms at the sides (elevating the arms distorts the breasts.
  3. current side view unclothed.

At 6 months it is not likely that much more change will occur unless there is a capsular contracture that is so far untreated. The implants look fairly even in the available views--I am not even certain which side is which--I assume by arm position the photos are taken in a mirror.

In terms of "error" vs "anatomy" those are not the only possibilities, but without more info, it is hard to sort the possibilities out. 

All the best. 



Jourdan Gottlieb, MD
Seattle Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.