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?

Alejandro Nogueira, MD · Answer

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.

Matthew S. Kilgo, MD · Answer

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.

Daniel Barrett, MD · Answer

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

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

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

Answers (8)

Answer: Breast lift

Answer: Breast lift

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

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

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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 (8)

Answer: Breast lift

Answer: Breast lift

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

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

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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.