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

Question

I originally underwent a breast lift with augmentation after losing 100 pounds. Following the procedure, I developed lower pole stretch, which caused my nipples to appear too high. I then saw a different surgeon for a revision. During that surgery, he corrected the implant pocket and placed Galaflex mesh for additional support. Unfortunately, that did not resolve the issue. He believed the problem was due to my implants being too large, so I underwent a third surgery to downsize the implants from 350cc to 310cc. After three surgeries, I’m still unhappy with the outcome. My breasts are flat where the mesh was placed, my nipples appear too high, and the overall appearance is distorted with indentations. The shape of my breasts distort even more when I lay down or bend over, as if my skin separates or pulls from the implant. Is there anything that can fix this?

Ronald J. Edelson, MD · Answer

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

Dallas Buchanan, MD · Answer

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

Leland Deane, MD, FACS · Answer

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.

Darryl J. Blinski, MD · Answer

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

Mats Hagstrom, MD (license on probation) · Answer

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

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

Answers (5)

Answer: Multiple breast surgeries, following weight loss areas of continued deformity options

Answer: Multiple breast surgeries, following weight loss areas of continued deformity options

Answer: Breast surgery outcomes

Answer: Breast surgery outcomes

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Everything you need to know about Breast Implant Revision

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

Answers (5)

Answer: Multiple breast surgeries, following weight loss areas of continued deformity options

Answer: Multiple breast surgeries, following weight loss areas of continued deformity options

Answer: Breast surgery outcomes

Answer: Breast surgery outcomes

Browse related questions

Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.