Is the best way to fix my bad breast reduction a breast fat transfer or implants? (photos)

Question

What is the best way to fix? I'm 10 months post op. Breast Reduction - short scar technique. Puckering and indent on left breast (you can feel a hole in breast) and nipples shifted outward. I wanted to be a large/full C and I am came out a regular B. I was previously a very full saggy D (left) DD (right) also think my breast are bottoming out. I want to be a large/very full C. Fat transfer is preferred But open to options.

S. Larry Schlesinger, MD, FACS · Answer

Obviously, an in person exam would give the greatest amount of information.That being said, based on the photographs you sent, it appears that the vertical incision from your nipple to your inframammary fold is too long.  If a higher horizontal incision of normal length, was done it would correct the apparent bottoming out, give fullness to the upper quadrant of your breast, and possibly obviate the necessity for fat grafting and/or the placement of a breast implant.Your nipples turning outward and upward, I believe, are a function of the elongated vertical incision, and if this was shortened, your nipples would point in a more desirable position, both vertically and horizontally.I believe your plastic surgeon did a good job as far as he or she went, and this type of problem is experienced by all plastic surgeons who do lift/reductions at one time or another.  If I were you, I would go back and speak with your personal plastic surgeon.

Tim Neavin, MD · Answer

Thank you for your question and for your photos. An in person examination with a board certified surgeon would be best to discuss various treatment options and what results to expect. I feel that for now a breast revision surgery would be best to remove the inferior skin.

Stephen M. Krant, MD, FACS · Answer

First of all, it seems that your “short scar” appears quite
long, thus the “bottoming out” look. To correct the deformity, the mastopexy
needs to be redone with shortening of the vertical scar to about 4-5 cm from
the bottom of the areola to the inframammary crease . . . and extend the
horizontal scar as necessary.  This will
give you the ideal shape and contour.
            Secondly, if
you want to be that full C cup, a submuscular prosthesis can be placed at the
same time . . . or “stage it” and do the “augmentation” at a second stage
months later. Also, it may need support with AlloDerm (human) or Strattice
(pigskin) to act like a sling for the prosthesis.
            The end
result should be a full C cup (size) and a well-contoured (shape) breast. Fat
transfer is not the “preferred” option at this point. Do the
augmentation/mastopexy first . . . and then do autologous fat transfer
to “fine tune” the result months later – if it is even necessary.  
Good luck!

Pejman Aflaki, MD · Answer

Hello and thank you for your question and sharing your photos. I believe you benefit from a revision surgery, to remove some of the redundant inferior pole skin at the fold in a horizontal fashion. Fat grafting and implants are both reasonable options. You should discuss the pros and cons of each with your plastic surgeon. Best,

Robert Cohen, MD · Answer

You need a formal evaluation by a licensed plastic surgeon and expert in breast revisions to determine what is best for you and your goals.
Corrective breast surgery encompasses the correction of an array of problems that can occur after breast augmentation or other aesthetic breast surgeries. It is considered the most challenging aesthetic surgery of the breast and requires a range of techniques, including the use of acellular dermal matrices, fat grafting, internal pocket adjustments, and external skin tightening maneuvers. Although highly complex, I find this surgery fascinating as it puts to use all of my skills to solve unique issues. Some patients may be traumatized by their previous experiences, so strong communication skills are vital to understand a patient’s goals and to help them understand the kind of improvements we can achieve.
This type of surgery is extremely important for the patients suffering from deformities, and my experience with these complicated cases also helps me provide excellent results and minimize complications with more routine breast augmentations and mastopexies.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Revisions. - Dr. Cohen

Francis Johns, MD · Answer

Thank you for your question.Based on your photos, I would suggest an augmentation with skin tightening. The implants will give you the upper pole fullness you want. The breast lift will tighten the skin and make everything more symmetric.

Kenneth Hughes, MD · Answer

Overall I think it is a very good result.  You could perform a minor revision to remove more skin.

Gerald Minniti, MD, FACS · Answer

Hello,All you need is a revision to a full anchor scar lift. The contour irregularities are due to skin excess in the vertical vector due to insufficient skin removal in that direction. It would be very easy and would not involve your periareolar scars or most of your vertical scars. At ten months you can be assured this won't iron out or get better, and it is now time to revise.

Salih Onur Basat, MD, EBOPRAS · Answer

Hi and thanks for your question.
Based on your photos you need revision of your breast reduction. Especially in lower pole scar should be extended as an reverse T type . If you want to larger breast , I recommend breast implant for you . Fat injection can cause unpredictable result like asymmetry, hardness in breast tissue. Because of these reasons  I recommend breast implant for you . Implant gives more precise result than fat injection. This operation will be your second operation and I think this operation must be your last breast operation. 
Best of lucks.

Ronald J. Edelson, MD · Answer

Overall you have a pretty good result.  However the short scar technique left some looseness along the lower operation of the breast.  This is simple to revise but will require an incision along the inframammary fold to remove the excess skin.

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