One year post second surgery to correct tuberous breasts - Can I do anything to flatten and improve the nipple scars? (Photos)

Question

I have had surgery twice to attempt to correct my tuberous breasts. Once to lift, reduce the areolas and fat transfer. The second to do the same again but inserting silicone implants instead of fat. The second surgery was about a year ago. My right breast feels a lot firmer and sits higher. The implant is bigger because that breast was slightly smaller. Should I be concerned? My nipples are scarred and raised. I didn't really use the kelo cote silicone gel because I felt so disheartened with the results in general. I have started using the gel in case it helps. Can I do anything to flatten and improve the nipple scars? Are these the best results I can expect? I am so unhappy and have tried eveything I can think. I have had a past boyfriend be extremely unkind towards me. I just want to feel comfortable with my body. I would greatly appreciate any advice. I was partly unhappy with the size of my breasts too as I feel misled by what they would look like. They are small implants: BILATERAL SUBFASCIAL (OVER THE MUSCLE)_BREAST AUGMENTATION WITH 225ca (TO THE RIGHT BREAST AND 200CC (TO THE LEFT BREAST), ROUND, SMOOTH, MODERATE PLUS PROFILE, MENTOR SILICONE IMPLANTS AND PERIAREOLAR MASTOPEXY. Could further surgery give me a desirable outome?

Robert M. Lowen, MD · Answer

Dear jr1,  Yes, certainly revision can  improve this situation.  In the first place most of your implant volume is above the equator of the breast, and this should be reversed.  Why does this appearance exist?  1. There is inadequate skin below the areola, so the implant does not have a relaxed lower pole to sit in, and 2. the implants are too large, and accentuate the lack of skin in the lower breast by a compensatory bulge into the upper pole.  In addition the pressure of the implant against the areola puts tension on the periareolar scar, increasing scar formation. These are very large implants in relationship to the needed nipple to fold distance.  Even small or smaller implants will tend to be displaced upwards under these circumstances.
   Therefore, a logical approach would be to 1. lower the current inframmary fold to have adequate distance from nipple to chest wall, probably in the 8-9 cm range, and release any remnant traces of the current inframammary fold as much as possible, and consider fat-grafting or alloClae to camouflage any remnants that remain. 2. Make sure there is no capsular contracture contributing to the high, firm appearance of the right implant and release it if present. 3. choose smaller, more proportionate, cohesive implants, tailored more to a smaller nipple to fold distance than to the breast width.  This will take pressure off the upper pole and periareolar scar and look better. 4. Revise the periareolar scar with a wagon-wheel interlocking suture of permanent material, such as ethibond or goretex. 5. Decrease the incremental over sizing of the right implant.  Right now it looks too large compared to the left,  although this appearance may be due to capsular contracture, to be determined. 6. Start microbotox injections within two weeks of surgery into the periareolar scar and repeat every two weeks times two, then every two months, for a year.  Add scar laser is needed, 1540fractional erbium or similar.

One year post second surgery to correct tuberous breasts - Can I do anything to flatten and improve the nipple scars? (Photos)

Answers (1)

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