Differing Opinions on Breast Augmentation Revision

4 month post op. Plastic surgeon agrees that right breast needs to be fixed on bottom and left breast needs to fix on bottom. He said that he can stitch to make breasts higher but he said then my nipples would point downward. I went for another opinion and the other Plastic Surgeon said he would stitch the crease up and my nipples would not point downward. Before implants I was borderline pstosis grade b. I have 304cc under the muscle. Which one do I believe?

Doctor Answers 9

Revision breast augmentation requires sophistication.

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1)  I would respectfully disagree with both opinions.

2)  Your nipples will definitely not point down after revision breast augmentation.

3)  Your left breast needs very little work.  Just a few stitches with "capsulorrhaphy".

4)  Your right breast needs a lot of work, and will not be corrected just with stitches.  There is a "slash"- like deformity on the lower inside of your right breast which requires quite a bit of dissection to correct.  Plus some stitches.  Before the end of the operation, we put the patient in the sitting position (you are still asleep, of course) to make sure the new shape and symmetry are perfect.

5)  Your right breast appears smaller, and may need a slightly  larger implant.  During surgery, we put sterile disposable implant SIZERS into the breasts before deciding on the permanent implants.  This takes all the guess work out.

Manhattan Plastic Surgeon

Better is ALWAYS the Enemy of good with Cosmetic Surger

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I agree with Dr. Rand. I find nothing wrong with you Left breast. Your Right brerast appears to have an incompletely developed pocket along the inner, lower border which could bre released rather easily. I would recommend you just have a revision of the lower aspect of your right breast pocket and stop there. The result will be nice and you will not risk the complications associated with multiple breast implant operations.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Differing Opinions on Breast Augmentation Revision

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Thank you for the question. It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices.  It is quite amazing how adamant each plastic surgeon can be about the superiority of his/her recommendations…

Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible.   If I were you, I would ask to see as many examples as possible of similar patients who your plastic surgeons have helped with revisionary breast surgery.  Sorry that I cannot be more specific when I comes to your specific situation. I hope this, and the attached link (dedicated to revisionary breast surgery concerns), helps.  Best wishes.

Wait to Revise Your Breast Augmentation Then do it right if you do indeed need a revision!

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If you revise go with a lower projection wider implant and preferably use a subfascial technique.  The problems with the base of your breasts are caused mostly by the muscular forces of the dual-plane augmentation which push the implant down and out and the narrow highly projecting implant.  I dont think a simple stitch is going to make you happy.  You need the implant to occupy more medial space that is currently empty.  THis is why I use the Cold-Subfascial Breast Augmentation technique.  In reality your result is pretty good compared to the average dual-plane augmentation.  I would also advise waiting a few months because the inferior pole is going to continue to change.  I hope this helps!

All the best,

Rian A. Maercks M.D.

Revision augmentation

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It is difficult to comment fromt he single photo. If you had some ptosis before and the surgeon lowered your fold, it can lead to double bubble. If a patient needs  a lift then she should have a lift procedure, because double bubbles are harder to deal with.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Consider revision options carefully

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No one can give you specific advice baed only on a picture, especially in cases like yours. One reason you have heard different opinions is that there are more factors involved than it may seem at first. These include any pre-existing asymmetry, implant size and diameter, the degree of sagging, and more. Stitching the crease up will shorten the distasnce from the crease to the nipple and move the implant up, so this affects the nipple relative to the breast mound.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Correction of breast asymmetry and persistent sagging (ptosis) Photos/Pics

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My guess is that you want something other than just correction of asymmetry, It appears that putting a slightly larger implant on the right will produce diminshed asymmetry. However, from your description, it sounds more like you want "perky breasts". This will require a vertical scar with slight overcompensaiton and the likelihood of early downward pointing of the nipples.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Breast Implant Revision for Asymmetry

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I agree with the opinions put forth by Drs. Rand and Aldea.  All you would need to do to get a more symmetric and natural appearing breast is to enlarge the right breast pocket where it appears flat and this should produce a more round appearance without major surgical work or recovery. 

Discuss this with your doctor and see if you can agree on a plan.

Best of luck.

Vincent Marin, MD, FACS

La Jolla Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Breast implant revisions through the axilla

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From your photo it looks like all you really need is to release the lower inner crease on your right side where it looks a bit flat.  I don't see the problem on the left side but all I have is this one photo.  From a tough starting point maybe you should keep the revision simple and try to be happy with the improvement you got.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.