Surgeon offered third procedure in office, under local, to remove excess skin he blames for this result. (Photo)

Question

53, 5’11”, 183 lbs I’ve gotten a second opinion and what I was told would be required to fix this isn’t removing excess skin in a medical office, under local anesthesia, for a fee of $1000. I’m devastated by these results, and his offer insults my intelligence, because it’s a band aid at best. I was a 36DD before the surgery, with a fair degree of loose skin and grade 3 ptosis. I requested a 36C, was told a 36D would be more appropriate, and now I’m a 36E.

Gary M. Horndeski, MD · Answer

Your breasts are still low on the chest wall and the nipple are pointing upward. At this time, the best thing for you would be, taking you back to the operating room under general anesthesia, resect the inferior scars and some breast tissue. This will reposition the nipple-areola complex so it is pointing forward not upward and remove some excess volume.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

From your photos and description of your surgical goals a surgical revision is needed with excess skin and breast volume reduction.  General anesthesia would be recommended for your comfort and safety.  The shape of the breasts can be addressed with a revision as well.

Connie Hiers, MD, FACS · Answer

Your implants are too large and heavy for your tissue to support. It would be best to go down and size and relift.  What your surgeon is offering will make it some better for a while, then you will stretch from the weight and sag again. Go smaller and you will have a better chance of the lift holding.

Mats Hagstrom, MD (license on probation) · Answer

I’m sorry you find yourself unhappy with the outcome of your procedure. 
To make a quality assessment regarding the outcome of any plastic surgery procedure we always need to see a complete set of proper before and after pictures. If you don’t have before and after pictures then ask your surgeon to forward the pictures they took.
Seeing before pictures tells us your candidacy or “potential” for quality outcomes. Not all patients seeking cosmetic surgery are ideal candidates candidates for perfect outcomes. Quality outcomes are usually a balance between candidacy and provider skill. In the end both are probably equally as important. The patient who is an exceptional candidate, has the potential for exceptional outcomes if the procedure is done well. The patient who is not an exceptional candidate for surgery should not expect exceptional article, regardless of who does the procedure. Understanding your own candidacy for cosmetic surgery, and provider selection are the two critical hallmarks when it comes to long-term quality outcomes.
Mastopexy augmentation is a complex procedure that has inherent risk involved. Some surgeons do these as staged or separate procedures to minimize the chance of disasterous complications.
Pulling the skin tight while augmenting the breast with implants increases the chance of having complications. Augmentation mastopexy has a fairly high revision rate. What you are experiencing is not all that uncommon. 
Your candidacy for a quality of breast augmentation may not have been as high as you had previously thought.
While the results are not ideal, they are probably fairly typical for average outcomes based on your candidacy. 
Pulling the skin tight during this procedure can leave devastating complication, including complete necrosis of the entire nipple, areola complex, loss of the implant, total breast disfigurement comparable to mastectomy surgery.
It’s far better to go back and tighten the skin envelope as a second touchup procedure then to push the envelope to get the best results which will increases the risk of complications dramatically.
It sounds like your provider is trying to work with you and willing to help you. Perhaps, charging a revision fee is being a little self-serving. All patients should discuss revision rate and revision policy during in-person consultations before signing up for surgery. 
Each plastic surgeon will have their own policies and ways of handling each situation and outcome. This should ideally be discussed in detail during in person consultations. 
This is also true for implant size decisions. 
Your surgeon is responsible for your outcome and your well-being in in regards to the surgical procedure while you are responsible for choosing that provider. 
I recommend you continue working with your provider. If you feel you’re better served by having another surgeon take over your care, then that is your prerogative.
The following are some general guidelines for how I recommend patients choose surgeons for their procedures. 
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results look like or what your results are likely to be in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body to use as reference when reviewing before and after pictures. The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

Surgeon offered third procedure in office, under local, to remove excess skin he blames for this result. (Photo)

Answers (4)

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