Three surgeries — breasts are flat where the mesh was placed and nipples appear too high. What else can be done to fix this?

Post weight-loss breast implants placement are challeging or differential to other cases in one aspect: should they fail to stick firmly to the chest... the bottoming out is enormous and badly deforming. If any breast is prone to this deformity when the implants fail to heal well with the ribcage, a normal breast with no or mild tissue disruption may develope slight or moderate bottimg out, even none when the skin is thick and firm. However, in post weight-loss or massive breast-feeding enlargement cases the attention and technical planning has to spin around the obtention of a solid self-sustained fixation of the prostheses.

How to achieve this? A multiproged strategy:
-meticulous technique, as always
-highly adherent breast implants: macrotextured or biovelcro (polyurethane coated)
-strict and meticulous immobility during 4 weeks (that's the healing time of breast implants), locked down at home and with total arm discharge

Other theories are simple myths, it is irrelevant the plane of location regarding the muscle, using artificial meshes (they are a technical fraud, as you have experienced, if not risky), going for "light weighted implants" (come on, we are supposed to be serious people in the industry), etc.

Your case is quite standard in the office and hands of a revision specialist, it is a problem of free floating implants associated with laxity of the skin, leading to a bad grade of bottimg out.

You just need:
-polyurethane coated implants
-breat lift patter revision to adjust the lowe pole's skin
-mental preparation to go through 4 weks of absolute immbolity at home, absolute means absolute, no questioning

Find a serious professional with real hands-on experience in easy revisiou cases like yours.

I am so sorry that you have had these issues. The bottom line is that your surgeon would be the best person to honestly appraise the issues related to the surgeries done. You can see other opinions, and these need to be done in person. There will be a variety of suggestions and I would seek the most experienced doctors you can find.

In general, the mastopexy/augmentation combined operation has had problems for years and this is well known, with a satisfaction rate substantially below other operations. This involves all techniques, surgeons, materials, etc. For many years, I have been doing a single procedure first (either mastopexy or augmentation, but not both at the same time), as recommended by many experts, and this has served me and my patients very well. A secondary surgery (either augmentation or mastopexy) then becomes much more accurate and the chances of good success are much better, with less scarring and nipples which are in the proper position.

Hello and thank you for your question. It is difficult to provide specific recommendations without a breast examination. However, based on your photographs, it appears you have a "double bubble" deformity and an elongated distance from the nipples to the inframammary fold, which can create the appearance of a "high riding nipple". Surgical options depend largely on physical findings and may involve a change of plane ( from submuscular to sub fascial) and/or pocket modification with a reduction in the distance from the nipple to fold by removing breast tissue along to lower breast, resulting in an "inverted T" scar. If you decide to seek another opinion, be sure to consult with a plastic surgeon certified by the American Board of Plastic Surgery with extensive experience in revisional breast procedures. I hope this helps. Good luck.

Dear cobble678,

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

You actually got a good result from a very difficult procedure. The only thing that I would recommend is tightening the lower pole of the breast by cutting out excess skin in the lower part of the breast. I would not change the implant or pocket at all. Very simple revision. Your result is not perfect but it’s actually a good result given the challenging nature of the procedure

Thank you for your pictures and questions. These types of revision procedures can be difficult to perform and to predict how the procedure heals. In addition, your history of weight loss means that that skin is damaged and not prone to healing in predictable ways.
Right now it appears that the nipple-to-fold distance is too long and there is some degree of "pseudoptosis" of the breast. This is why the nipple appears too high - it is not that the nipple is too high but that the implant is too low in relation. The fold needs to be reconstructed. The flatness is a result of the mesh not being placed in a way that allows for expansion of the lower pole over time. And I think if you have excess skin and want to be larger overall, you would probably benefit from a larger and more projected implant (not sure if you current 310 is moderate profile but I would guess yes). Hope this helps!
Dallas Buchanan
VIVIFY plastic surgery
Tampa FL

Based on your series of nicely posted photos, in my opinion, you have two options to fix or repair the indented nipple complexes, and the flatness of the inferior breast pulled centrally. Option one – is liposuction with fat graphs to those areas under ultrasound guided injection. Fee $8000. Option two – is non-surgical injection of ALLOCLAE injections Approximately 100 cc fee $18,000 due to the expense of the product. Best of virtual consult with for a better understanding regards

Your situation is complex.
It’s difficult to get a good understanding of what the primary problem is because you had a lift and previous multiple procedures.
It’s hard to tell if the IMF (infra mammary fold) has been opened and your implants are bottoming out or if the nipple position was placed too high during your breast lift.
Because of the complex nature, better information is needed to get a good assessment.
This should include complete before and after pictures of each of the procedures.
At this point, I recommend you focus exclusively on in person consultations.
For second opinion, consultations, come prepared, bringing with you before and after pictures for each of your previous procedures and copies of each of the operative reports.
These are all part of your medical records that you can request from each of the providers.
If the nipple position was placed too high during the breast lift, then it’s going to be very difficult to get a good outcome.
If however, the implant has bottomed out and that is all that needs to be corrected. Then that may be doable.
Which each previous procedure things became more difficult and complex.
Each time you have surgery the chance of a high-quality final outcome goes down. It would be particularly helpful to see before and after pictures after your first procedure.
Before we recommend an operation, we need to have a clear understanding of what the problem is.
This primarily entails understanding where your initial IMF was and the relationship to your IMF and the current nipple position.
Best,
Mats Hagstrom MD