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