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

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.

Unfortunately age, changes in weight, pregnancy and breast feeding can all cause breast tissue to lose its elasticity. It looks as though your breast have relaxed significantly after your breast lift, it also appears as though your implants have migrated downward to fill in the excess skin. When doing a breast lift and breast augmentation at the same time, you often run the risk suffocating and killing the nipple, because of this, the surgeon was likely not as aggressive as they could have been while doing your procedure. For this reason, I often require my patients to stage these two procedures. I will typically do the breast lift first, which will allow me to make the breast as tight as possible with out running the risk of any tissue death. I then allow the breast heal and breast tissue to strengthen over a period of 8-12 weeks before bringing the patient back for the breast augmentation. I believe you may need a secondary breast lift with re-positioning of your implants, this may involve some capsule work but you should be able to keep your current breast implants. Best of luck to you. 

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.

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"

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

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.

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.

Hello Anna.  This is an excellent question that should help others with these concerns.  Without seeing post operative pictures, it sounds like you are either having some return of skin laxity or displacement of your implants (dropping below the crease or stretching of the pocket where the implant sits).  Both of these can happen no matter how perfect the breast lift surgery was performed.  Post-operative sag happens.  Factors that may cause it to happen quicker than expected include skin quality, type of lift performed and the weight of the implant.  Revisions can be performed.  Going to a larger size means a heavier implant that may cause the problem to reoccur.  

Breast sagging after a breast lift with implants can occur due to factors like aging, pregnancy, weight fluctuations, or inadequate support. It’s essential to consult with your surgeon to discuss your specific case and explore potential reasons for the outcome.

Immediately following a breast lift with implants the implants are typically high on the chest wall as the vertical incision in the lower pole of the breast is tight.  Over the first few months, the implants begin to drop and settle into position with the effect of gravity.  The skin of the lower pole that was initially flat begins to round out as it stretches from the weight of the implants and breast tissue.  This effect can be even more pronounced following massive weight loss (such as the 50 lbs in one year you described).  Various maneuvers are performed during surgery such as placement of sutures in the breast tissue itself rather than just the skin to provide support to the lower poles to counteract the effect of gravity, but the implants will inevitably drop some after surgery.  This process takes about 6 - 12 months.  Sometimes the distance from the nipple to fold can become excessively long with the effect of stretching of the lower poles, resulting in upward pointing nipples.  Based on your photograph, you appear to have a satisfactory result with nipples that are slightly high.  If you are still unhappy with the appearance of your breasts with further descent of the breasts at 1 year, you may consider a revision lift.  I would recommend following up closely with your plastic surgeon.  Good communication between patient and surgeon is very important both before and after surgery.  Best of luck in your recovery!
Ziyad Hammoudeh, MD