How do I fix these indentations in my breast and what has caused it? (Photos)

You have what appears to be classic issues when a donut mastopexy is performed on a breast that needs a true mastopexy. These issues include flattening of the breast mound, persistent lower pole ptosis, thick scars and persistently wide areola with periareolar pleating. Also, it appears that your implants were placed through the same incision; the infra-areolar dents are vertical scars that go from the skin to the periprosthetic capsule that only occur when implants are placed through this incision. If you really want a beautiful breast, you'll need to convert to a full mastopexy and it will take care of all these issues.

In my opinion, your implants are too large for your breasts. I'd suggest downsizing and doing a breast lift to remove excess skin and lift and shape your breasts.

An examination is needed to be certain, but you either have some loose skin which can be tightened with more lifting around the areolae, or you have some scar tissue that has compressed breast tissue. This scar tissue will be harder to fill. Sculptra injections might work better than fat in scar tissue.

To make a quality assessment regarding the outcome of a plastic surgery procedure we need to see a complete set up her before and after pictures. If you don’t have before and after pictures, then ask your surgeon to forward the picture. If you’ve had more than one procedure that we need to see before and after pictures for each of your previous procedures.
If you’ve had a mastopexy, then we should know what type of mastopexy you had?
My best guess is that you may have had an insufficient breast lift perhaps a donut or Benelli mastopexy when you needed a more extensive procedure.
At this point, we can’t really make an assessment based on the information provided.
Hi, suggest following up with your provider and discussing your concerns with him or her. Alternatively, you can schedule in person second opinion consultations with other plastic surgeons in your community.
My best guess is you were not a good candidate for a doughnut, mastopexy, a.k.a. Benelli mastopexy and once you go down that road, it’s difficult to convert to a proper mastopexy.
I don’t see the indication for fat transfer and I question why that was the recommended procedure?
Best,
Mats Hagstrom, MD