Failed lift/augmentation and revision. Third surgery in less that 2 years (Photo)

Question

38 year old with compromised skin post pregnancy/breastfeeding. After 2 failed surgeries augmentation/areola reduction and revision lift/areola reduction) this is what I’m left with. Surgeon claims he did nothing wrong. I almost 20k in surgeries and he has the nerve to expect me to pay for a THIRD surgery? I have already chosen a new surgeon but think there should be accountability on his end. How do my breasts look like this after two surgeries? I’m disgusted.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revision breast surgery.  In your case, I would perform reductive augmentation.  This is a procedure that I pioneered and published in 2017.  This would include  re-augmentation, capsulorrhaphy-internal bra, mirror image capsulotomy-opening up the pocket on the top, and revising the lift-mastopexy.  Since your tissues have been violated several times, I would also use mesh to support the implant.  There is no question that you should be able to achieve an excellent result.  Best wishes to you.

Gary M. Horndeski, MD · Answer

The technique I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear jmo84,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

I am so sorry that you are having these problems. Your tissue is not supporting the weight of your current implants. You could consider going smaller with a lift and mesh of an internal bra. Some tissue once stretched never holds well.  It is not really possible to know whose tissue will maintain support and whose will not until after the procedure is done.

Karl William Schwarz, MD · Answer

This is a tough problem and I sympathize with you.

It may be tough to hear this, but I would fear you will have a similar result after your third surgery. The problem doesn't lie with your surgeon, the problem lies with your tissue. Some patients are what I call "rapid re-droopers" in that they have a very fast recurrence of the droop. And it is maddening because it is the whole reason why they have surgery in the first place--they hate the droop.

Unfortunately your tissue is just not strong enough to support a breast implant and I have made plenty of prospective patients cry when I tell them they are not candidates for an implant. I think there are some patients who just have very weak tissue for a variety of reasons who are just not good implant candidates.

The other issue is implants are best for women with narrow breasts as patients with wide breasts (as you have) are not good candidates for a breast implant--it just never looks good and the implant has to be very big to fit the wider breast and that compounds the problem of the weak tissue.

It is hard to hear, and I hate to be the one to tell patients who have this tissue this exact thing, but I would rather they cry and not have surgery than to proceed with surgery when I know the outcome will not be good. It is a huge expense, which you have experienced, and a long time recovering etc only to get a result you are not happy with.

The patient is left trying to find a better surgeon, thinking the first surgeon did a bad job, where the problem is just that their tissue is not up for carrying an implant. There are a lot of patients who appear to be a candidate for an implant but on examination they just don't have the tissue strength for it.

Sometimes it is better to accept this and forgo the implants and save yourself the expected path of re-droop and re-droop.

I have removed implants many times in rapid re-drooper patients who had surgery with another surgeon after they come to me and want me to redo the lift, but I tell them I would have the same result as their first surgeon. They are always a little surprised but once I explain the concept of a wide breast and the weak tissue they understand and it has been my experience these patients are very happy to have the implant removed and a lift performed. They will never be perky or have a large volume or upper pole fullness but they would never have that WITH an implant anyway as the implant just drops.

Darryl J. Blinski, MD · Answer

Nice posted before and after photos. It seems your elastic skin tissue is poor thus the stretching effect. I might offer mesh re lift with exchange implants and redo full lift. Fee $20,000. Best to virtual consult with...

Mark Eberbach, MD · Answer

He said it in the opening part of your question. Do you have compromised skin? I would probably say more compromised internal tissue. It is my guess that your breast tissue is fairly dense.

In my opinion, the only real effective way with your type breast is to do a lift with removal or repositioning of your lower whole tissues to a higher place on your chest. In your case now, this would likely represent at least a two-stage process to do a skin tightening with slight elevation of your nipple,  areolar complex and resection of the lower hold your breath and stage one. Stage two redo the augmentation.

Hey surgeon does not control your tissues. I'm sorry, however, that your tissues do not support the final shape and appearance, you desire with a simple operation.

Richard P. Rand, MD, FACS (retired) · Answer

Once you are at the point of a third surgery you are trying to salvage at least something of a result; clearly your tissue is not elastic and has no tightness. That has nothing to do with the surgeons work. But your before photo showed decent volume so you might consider removing the implants and re-tightening the lift. You would, for sure need an anchor shaped scar, and the vertical limb from the crease to the areola should be no more than 5 cm at the end of that surgery because it will stretch out a little bit. If it is shorter than yours is currently they won’t wind up looking baggy and bottom heavy down the road. If you insist on keeping implants (which will continue to cause some problems with bottom heaviness) at least be sure they’re under the muscle. But consider going without implants and just being smaller and tighter. You’d like this to be your last surgery.

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