2nd revision - How to improve shape and center areolas (photo)

Question

Hi Doctors, I started with a short areola to fold distance and slightly tuberous breast. 1y ago I had 250cc Moderate HSC+ implants placed dual plane thru the nipple. They never dropped. 4mo ago I had a revision w 305cc Mod+ HSC implants with donut lift and areola reduction. I’m worried my implants haven’t dropped yet and my fold seems to be the same if not a bit more round? I’ve included my wish pic above. My goal is more centered areola and prettier shape. Thank you for any advice

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your pictures. In order to have a more centered, nipple-areolar complex over an implant, your fold needs to be lowered. Therefore, a larger implant should be chosen versus your natural breast anatomy.

Best wishes

Earl Stephenson Jr, MD, DDS, MBA

ESJ Aesthetics

Best wishes

Earl Stephenson Jr, MD, DDS, MBA

ESJ Aesthetics

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question. 
It is difficult to provide recommendations without a full physical examination. Based on the  photographs provided ( which I assume were taken after your revision), it does appear that you have very tight lower
 poles with high inframmary folds. I would not pursue any more surgery for at least another 2 months to allow for additional implant settling. Correction may require more aggressive glandular scoring, lowering of the folds and a higher level dual plane. For best results always consult with a plastic surgeon certified by the American Board of Plastic Surgery with extensive experience in revisional breast surgery. I hope this helps. Good luck.

Wayne I. Yamahata, MD · Answer

To achieve your goals, i.e. to have your nipples centered on the breast mounds will require that the nipples be moved through a more standard type of lift. This will provide an increase in the distance between your nipples and the inframammary folds.

Daniel Barrett, MD · Answer

Dear Gregarious236767,

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

Gianfranco Frojo, MD · Answer

I would wait a full year prior to determining if the final position/settling has occurred. Sometimes it can take quite a while for proper tissue relaxation.

Farbod Esmailian, MD · Answer

Unfortunate to read about your disappointment. Your breast shape now looks much improved but your NAC and too low. Although I have not examined you, judging from the photos, I would not alter your folds at this point. I would recommend having a vertical (lollipop) mastopexy to bring your NAC to the desired location. This may need you to down size the implants, but again it may not, you would need a proper exam to determine that.

Not all hope is lost, good luck.

Not all hope is lost, good luck.

Gary M. Horndeski, MD · Answer

You have 3 alternatives: one is to lift the nipple-areola complex higher using a circumareola approach but that may be limited. The second is to lower the inframammary folds, which may lead to bottoming out of the implants. The last alternative is replacing with smaller implants.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

You need a lift to raise your areolae, and I would suggest not going any larger because of the shorter fold distance. If the fold is lowered, you run the risk of bottoming out with your implants.

2nd revision - How to improve shape and center areolas (photo)

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