Should I get a lift or is it bottoming out? Also, should I get lower profile currently (UHP) for more aesthetic look? (Photos)

I'm one year and four months post op and am unsatisfied with my outcome. I think the UHP my doctor recommended are not natural looking although he said they would be. I'm looking to get them fixed and would like recommendations on if a lift is needed or is it possibly bottoming out. They are not assymetric and way too big.

Doctor Answers 9

UHP implants

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Many PS's will use UHP large implants on patients with droop to avoid a lift. It works great in the short term and avoids lift scars. However, I am convinced that this method will often result in large breasts with the same amount or more droop. If your skin could not support the breast tissue you had, why would anyone think it could support the additional weight of an implant. 

I would need to perform a physical exam to be sure, but I would guess that removing the implant or replacing it with a smaller implant needs to be performed at the same time as a breast lift. 

Best of luck!

Bottomed out?

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It is hard to tell without a side picture.  You do not look bottomed out, but you may like a lift.  You can do smaller implants at that time if you wish.Good Luck!

Michael E. Decherd, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 61 reviews

Should I get a lift or is it bottoming out? Also, should I get lower profile currently (UHP) for more aesthetic look

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Thank you for your question.  You don't have bottoming out of your implant.  A breast lift with smaller implant would improve the shape and size of your breasts. Consult with a board certified plastic surgeon.  Best Wishes

Persistent Breast Droop after Augmentation

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I am sorry you are having problems. This is not "bottoming out" but a very typical result of placing implants without doing a lift when one is indicated. It has very little to do with the implant profile, though, the higher the profile, the more the breasts fall off the implant. Since your breasts are "way too big," I would suggest consulting with an experienced hard certified plastic surgeon for exchange of implants for smaller ones and a lift. For someone who understands how this is done, it can be done in one session.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Do I need a Breast Lift?

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Thanks for your question.  Unfortunately, from just your photos it is impossible to give a recommendation.  If you feel your implants are too large, I think it would be reasonable to exchange the implants.  You will probably also want to consider a mastopexy or breast lift.  There are many factors to consider in recommending the best surgical option for you.I would recommend seeing a few board certified plastic surgeons in your area to get their opinions.

Suresh Koneru, MD
San Antonio Plastic Surgeon
4.4 out of 5 stars 18 reviews

Lift or Bottoming Out

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Thanks for your question! I would agree that at this point, u should consider a lift, probably a circumvertical mastopexy. Based on my experience of doing hundreds of these per year, including combining them with implants, i think that'll give u the best overall result. Best of luck!

Robert P. Schmid, MD
Lubbock Plastic Surgeon
4.8 out of 5 stars 41 reviews

Should have had a lift

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This is not bottoming out.  You should have had a lift first.  A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved. The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies. Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Revision after BBA

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Thank you for your photos and question. I am sorry you're feeling unsatisfied with your results. It will be difficult for online consultants to give you an accurate answer as this would require a physical examination as well as an extensive discussion. That being said if you feel too large, then downsizing the implants is an obvious option. You do have some natural ptosis, and therefore a breast lift may be of benefit. It really depends on what your goals are and what your tolerance is for scarring. Some patients may be willing to accept a less lifted look in order to avoid scars.  An in depth discussion with a board-certified plastic surgeon who can evaluate you and make  recommendations is the next step.  Best Regards

Best operation and implants for revisionary breast surgery?

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I am sorry to hear about your concerns after previous breast surgery. Choosing to proceed with revisionary breast surgery can be anxiety provoking for patients.   Good advice would require much more information;  for example,  careful physical examination and careful communication of concerns and goals (including a thorough discussion of potential risks/complications/pros/cons associated with all options under consideration) would be necessary.  In other words, ultimately, whether or not to proceed with revisionary breast surgery will be a very personal decision that only you can make after very careful consideration. You will need to weigh your degree of concerns regarding your breast appearance against the potential risks/complications associated with additional surgery.

Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “more aesthetic look” or "C or D cup” etc means different things to different people and therefore prove unhelpful.. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. 

3. Once you feel you have communicated your goals clearly,  allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.
I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps.

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.