Why are my breast sagging after a Breast Lift with Implants?

I'm 35 years old, 5'8 ft weight 178 lbs. I have lost 50 lbs within a year. I got surgery about 6 mos. ago (Mommy Maker) I told my PS I wanted full frim DDs cup. Post op I notice the position of the nipple is resting on top of the full part of the breast they aren't facing straight out but facing upward, nipples are now inverted, breast are fuller but have no full lift. Do I have to get a revision and go bigger to have breast lifted or does the PS needs to tighten the skin on the breast? Pre -op 36D, post -op 36 DD implants 305cc under the muscle. Didn't lose any more weight.

Doctor Answers 12

Bottoming out, inverted nipples and relapse of sagging breasts after breast lift and significant weight loss

 Gravity and genetics are the principle causes of saggy breasts. The larger the cup size after breast lift, the more prone the breast is towards relapse. It would be very unusual to have perky, full firm DD breasts that did not sag to a greater or lesser degree after breast lift.You didn't mention the size or shape of the implants or where they were placed (above or below muscle)..
Breast lifts are better done AFTER you have finished losing weight. Let's assume your breast lift was done at the midpoint of your 50 lb weight loss. Even a 25 lb weight loss after a breast lift is sufficient to cause relapse of sagging breasts because while the breast volume and weight  will decrease with continued weight loss, the breast skin envelope does not shrink. This in turn results in a bigger bag holding a smaller breast volume and sagging.
If you have wide stretchmarks on your breasts from when you were bigger, then your breast skin will have a tendency to not stay tight after a breast lift. Additional weight loss under these circumstances frequently leads to relapse of sagging, high riding inverted upward deflecting nipples and a heavy bottom portion of the breast (bottoming out).. 
I don't think you should consider going bigger. Revising the lift via additional skin tightening may improve upon the sagging, and consideration of a smaller implant may be beneficial. The use of acellular dermal matrix is expensive, labor intensive and can lead to additional surgical revisions.

Las Vegas Plastic Surgeon
4.3 out of 5 stars 11 reviews

Revision of an implant & lift sometimes requires internal support

Forces which can unfavorably alter the elasticity of breast skin include weight gain & loss, pregnancy and aging.  
When the breast skin brassiere is too stretchy, you may not be able to maintain that ideal "high and tight" & firm
DD, not because of anything that your PS did or didn't do but because the "carrying capacity" of your breast skin
cannot hold the weight of the implant.  :(  If you want a "hand in glove" fit, which sits higher on your chest, you may have to consider the use of acellular dermal matrix, like Strattice, to provide a "hammock" to support the
implant.  The procedure is technically vigorous and expensive, so do discuss all aspects with your PS before
proceeding.  Recently, a silk engineered product, Seri scaffolding has become FDA approved, so this may 
provide a slightly less expensive option.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Residual Breast Sag

It's not unusual for massive weight loss patients to have poor skin tone. For these reasons, they're especially prone to recurrent skin sag. Under these circumstances, it's not unusual for massive weight loss patients to require revisional surgery following the combination of breast augmentation and breast lift surgery.

Although it's virtually impossible to make a specific recommendation without performing a physical examination, your history suggests that your implants have bottomed out. This occurs when the implants stretch the soft tissue and are inferiorly mal-positioned. This usually always requires revisional surgery.

Surgical correction usually requires elevation of the breast implant pocket to raise the implant position. Correction may also require adjustment of the soft tissue envelope by revising the breast lift procedure. In this case, the vertical distance between the areola and the inframammary fold might need to be shortened with a transverse skin resection. Revisional surgery should be delayed for at least six months to allow adequate wound healing and resolution of swelling.

In the interim, it's important to be patient and maintain good communication with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your concerns.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Why are my breast sagging after a Breast Lift with Implants

Thank ypu for ypur question. You have some bottoming out of your implants.  Six months is a good time to begin discussion regarding a breast lift revision. Discuss ypur options with your Plastic Surgeon.   Best Wishes.

Jeff Angobaldo, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 104 reviews

Breast Lift with Implants

Hi Anna,
Sorry you are dropping a little.  Because your skin is stretchy, you may need to remove some more.  Be sure to get down to your fight weight if you have more skin removed.  The larger the implant, the more weight is in your breast, and gravity will pull things down more.  So I like your size of 305.  Check back with your surgeon, and describe what you have said above, give it some time, and if necessary, return for more skin removal.  All the best,  "Dr. Joe"

Joe Gryskiewicz, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 269 reviews

Recurrent sagging after breast lift plus implants 6 months ago.

Thanks for your photos. They show additional skin stretch and some degree of bottoming out. With stretched skin (even after a lift), there is never a return of lost elasticity after breast lift, since the same stretched skin is being reconfigured and tailored into the new higher tighter skin brassiere. But it's still the same stretched skin!

Either this was a poorly-designed lift (lower breast flaps too long), or a beautifully-designed lift with damaged skin whose innate loss of elasticity was not taken into account. Firm was probably never an option, even with implants (unless you and/or your surgeon planned on capsular contracture).

Bigger implants will further fill your presently still-loose skin, and revision of your entire lift by removing additional skin can further tighten your skin brassiere. But larger implants and even less skin to contain them does not necessarily = high and firm. More likely, it leads to recurrent droop and additional dissatisfaction, or maybe even wound breakdown and disaster.

Please understand that this is not a function of the "right" surgeon or a "better" surgical plan. You cannot rewrite the laws of physics (gravity acting on large masses) no matter how much you might want to. Sorry. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Breast implants bottoming out after breast lift and augmentation may need a revision

A photo would help.  However based in your description it sounds as though your implants have descended or dropped beneath your nipple areola and are causing the nipple and areola to a point upward and outward.  If this is the case the implants may have bottomed out.   This may require a surgical revision to close the breast implant pocket too forcefully implants higher.  Please see your plastic surgeon.

For more information on breast implant revision please read the following link:

Implant issues: upward nipples

Obviously, the picture would be helpful. It sounds like your implants either have bottom out or incorrectly placed. Either way a revision and downsizing implants may be necessary.

Breast lift

This is very hard to say without pictures.
If you observe a recurrence of sagginess,I caution against bigger implants.
Should your tissues not withhold the weight, increasing the implant size is not a good idea.
You may want to consider reposting your question with some photos, this would put myself or any other participating collegue here in a better position to respond.

Alexander Aslani, MD
Spain Plastic Surgeon
4.8 out of 5 stars 301 reviews

Lift and implants

Without seeing photos, it is difficult to say. Based upon your description it sounds like you may have bottomed out. Without photos I can not say.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

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.