How to go bigger safely? Revision? (Photo)

Question

Can I go bigger, reposition my scars to the crease. Can my scar skin be pulls down & sewed to my crease? How will DRs make sure new crease will stay put? Can I realistically go up to 525cc HP without too much upper pull. Can i realistically have lower pull fullness after scar is tucked under the crease & size increase? Current implants 375cc moderate plus. I still want the bottom of my breast to be Round but will scar tucking ruin the roundness at the bottom? Need realistic answers

Daniel Barrett, MD · Answer

Dear evangeline jamie,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Bennett Yang, MD · Answer

Hello and thank you for the photos and the question. All breast augmentation procedures involve some dropping of the implant during the healing process. this is normal it's important that when the procedure is done that the pocket for the implant created properly fits the implant, and should be neither too large nor too small. Under the muscle implants are the preferred way to do this procedure however sometimes the activation of the muscle overtime creates downward pressure on the implant pushing it lower and lower. It is important to remember that after a sub muscular implant is placed that very little upper body exercises performed during the healing process. Based on your photos, you have an excellent overall shape end result from your plastic surgeon. There are different methods and techniques designed to lift the implant pocket and tighten this area to keep this scar in the crease however none of that is guaranteed and if you go to a larger implant it almost always will lead to further dropping of the implant pocket.  I don't advise you do these things at the same time. If you are determined to go with a bigger implant, I would suggest you do that first, then wait a year to allow for adequate healing. At that point in time your plastic surgeon can determine how much to raise the pocket and tighten the lower pole of the soft tissues to prevent the pocket from dropping too low. Regardless, there will still be a little bit of dropping of the pocket because of gravity and the activation of your pectoralis muscle and you should be prepared for this. 
Remember to be healthy, no smoking, and make sure any medical conditions you have are being managed by your primary care MD. Best to you.

Connie Hiers, MD, FACS · Answer

Your tissue is not supporting the weight of the implants you currently have and will not support heavier implants. Your inferior pocket can be lifted and tightened and mesh can be used as an internal bra for better support.  Don't go bigger. Also, you will need to wear good supporting bras so this does not happen again.

Mats Hagstrom, MD (license on probation) · Answer

Your implants have bottomed out and this is one of the reason your scar is now no longer in the inframammary fold but sitting on your breast.
The surgical management of bottomed out implants is technically challenging and not simple or straightforward. The outcome is highly dependent on who does the procedure. Sometimes the correction can be done using reinforcing sutures, and sometimes using either mesh or cadaver dermis like a Alloderm can help support the position of the implant.
The inframammary fold may look slightly unnatural early after the revision. Usually it improves with time. Increasing the size of the implant at the same time may be pushing the envelope, and you should have a thorough discussion with the surgeon who is planning on doing your revision surgery about this.
The most important variable is provider selection.
Plastic surgeons who are good at breast augmentation should not have problems with implants bottoming out. Sufficient pectoralis muscle needs to be maintained to not allow the implant to slide down below the inframammary fold. 
Make sure your surgeon has done this procedure many times in the past with high-quality outcomes. Ask them to show you numerous before and after pictures of previous cases that they were done.
The time to be critical of plastic surgeons is during the vetting process when you’re choosing providers. To find the best provider, I suggest patients have multiple in person consultations. During each consultation, ask each provider to open up their portfolio and show their entire collection of before, and after pictures of previous patients who had similar body characteristics. Revision of work is not nearly as common as primarily procedurs.
For primary procedures and experience plastic surgeon, should not have any difficulty showing you the before, and after pictures of at least 50 previous patients for a commonly performed procedures. For revision, work providers may not have nearly as many before and after pictures to show you.
Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
Revision surgery is generally more difficult and more complex than primary procedures. The situation you have is particularly challenging to treat well with good aesthetic outcomes with long-term success, avoiding, repeat revision surgery.
Choose your provider well, then have faith in that providers ability. There’s no correct number of consultations needed to find the right provider. For complex procedures that are technically difficult the importance of provider selection becomes far greater. I often suggest patients consider having at least five consultations before choosing a provider. The biggest mistake most patients make is not being sufficiently selective and having to few consultations before scheduling surgery.
Best,
Mats Hagstrom, MD

How to go bigger safely? Revision? (Photo)

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