Botched breasts, best route? (Photo)

Question

I was AA and saved for 2 years to get BA. After healing, my implants were way up on chest and nipples were pointing to the floor. Young and trusting, I paid AGAIN full price for the surgeon to correct mistake. She switched implants for larger ones AND did a full lift. My areolas stretched over time and the scars widened. I’d love my areolas and nipples to be tiny. Best route?

Daniel Barrett, MD · Answer

Dear Christina907,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Daniel Butz, MD · Answer

I'm sorry to hear you're not happy with your result. 
You should be able to get a great result with a revision breast lift - reducing the areolar size, getting them higher and in the right position and improving the scar stretch. An exam might be helpful to determine if the implants/pockets need to modified. 
As much as it might be tempting to go back to your primary surgeon for a discount I'm not sure I would trust them if this is the result after 2 attempts. 
Get a few consults - 2nd/3rd opinions from board certified plastic surgeons - unfortunately  you may need to dig deep to verify this. You can always search on the American Board of Plastic Surgery website.

Ramiro Morales, Jr., MD · Answer

Thank you for your question and pictures.  From the look of your pictures you had a vertical lift which did not fully correct the look you are desiring.  This can be fixed with a full mastopexy, or breast lift, with an anchor scar.  The original surgeon may want to do this for you at no charge since you did not get the results you wanted but she may not want to.  Otherwise, you may need to see another board certified PS for you revision surgery.

Gerald Minniti, MD, FACS · Answer

I'll be candid, your results look like a non-board certified plastic surgeon did your surgery. You were never a candidate for breast augmentation without a lift in the first place, another worrisome sign your surgeon wasn't certified by the American Board of Plastic Surgery. Your scars are poor, and could be much better, and your lift is insufficient. Please find a real breast expert for this complex revision procedure.

Gary M. Horndeski, MD · Answer

At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

Once implant is still sitting somewhat high which makes your own breast tissue sag more. Ask your surgeon to trying oral Accolate, wearing the breast band, and external ultrasound treatments to try and lower that implant. Once lowered, you still might need the vertical lift.

Mats Hagstrom, MD (license on probation) · Answer

Quality breast augmentation outcomes are based on three variables.
The first is the patient candidacy for the procedure.
From, the information included. I’m guessing that you may not have been an ideal candidate for the procedure if you needed a breast lift.
If that’s the case, you should’ve been told you needed a lift during the consultation.
The second variable is the choice of implants in regards to size shape and type.
 Generally speaking working with excessively large implants is always going to increase the chance of undesirable side effects, complications and need for revision surgery.
The third variable is the skill of the provider.
For breast augmentation it’s basically the ability to put the implants in the correct and atomic location.For breast lift surgery it’s generally choosing the correct technique and delivering consistent quality outcomes.
I think in your case, the problem was primarily related to provider selection.
Your surgeon should’ve known if you needed a breast lift or not from the beginning.
It looks like you had a Benelli or donut type breast lift. In my opinion, this procedure is insufficient and causes stretching of your areolas.
It may seem ideal to not add the lollipop scar, or anchor scar but in your case that was what was needed.
I think a better breast lift technique would’ve saved you the grief and gotten you a better outcome.
Preferably this would’ve all been done correctly the first time.
It may seem very tempting to minimize the scars on the breast when recognizing you need a breast lift.
The Benelli breast lift is really limited.
It comes with major drawbacks.
Minimizing the scars has its price.
Generally speaking, I’m not a fan of this type of breast lift.
I use it selectively when a minimal lift is needed or if the areola needs to be reduced only.
Doing this type of lift sets patients up for problems later and burns bridges for quality outcomes with a proper breast lift if that’s needed. 
Plastic surgery outcomes are generally based on patient candidacy and provider selection.
Finding the right plastic surgeon is not easy or straightforward.
My best recommendation for provider selection is for patients to start the process by having multiple in person consultations over significant period of time.
Give yourself six months to interview six plastic surgeons.
 Take careful notes during each consultation.
Bring pictures of yourself the same way plastic surgeons take before and after pictures and use those pictures as reference during the consultation.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar body characteristics to your own.
 This is where you bring your own pictures to use as reference.
Being Shown a handful of pre-selected images representing the best results of providers career or of patients who had different body characteristics may be insufficient to get a clear understanding of what average results look like or what your results are likely to look like. 
An experienced plastic surgeon should have access to hundreds or preferably thousands of before, and after pictures to choose from.
They should be able to show you before and after pictures for longer than the scheduled consultation.
In a nutshell, an experience provider should be able to show you the before and after pictures of at least 50 previous patients.
You probably only need to see the before and after pictures of four or five previous patients, if the pictures are well selected and are very representative of what your body characteristics are.
Again, bring pictures of yourself to use as referenced during the consultation.
Take careful notes during the consultation, especially regarding the quantity and quality of before and after pictures.
Ask providers what their most common reason for revision surgery is. What is their revision rate and what is their revision policy?
Ask providers what their most common indication for doing revision surgery is.
Most patients don’t have a lot of experience consulting with plastic surgeons.
Plastic surgeons on the other hand have done thousands of consultations during their years of training and years in practice.
It takes practice to get good at doing consults and being good at doing consults will lead you to making good decisions, including finding the right provider.
In the hands of the right provider you would’ve had one operation and would’ve had quality outcome for at least a decade.
It’s not your fault that it’s difficult to find plastic surgeons who are really good at what they do.
This kind of work isn’t easy or straightforward and simply being bored certified in plastic surgery is not sufficient to confirm somebody has mastered this kind of work.
In fact, most plastic surgeons never mastered anything in their care. Most plastic surgeons remain average during their entire Career. that’s kind of the definition of average.
Only exceptional providers become exceptional.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
The second biggest mistake I see patients make is assuming that a plastic surgeon who have board certification, year of experience and a handful of positive reviews have mastered most plastic surgical procedures. Unfortunately, this is not true.
Doing plastic surgery really well on a consistent basis is simply much more difficult than most people realize.
If people see the consulting process, as if you’re hiring somebody to do a job for you, I think people would do better.
If you’re hiring someone for a position that you most likely want to interview multiple candidates before hiring someone.
Hiring someone to do surgery for you is really no different.
At this point if you want to improve your outcome, you’ll need to redo the breast lift because you had an insufficient procedure done.
If there is a fault, it was the choice of operation.
You needed a proper breast lift not a Benelli lift.
If you’re still working with the same surgeon them then I suggest you switch lanes and find somebody who is truly mastered did this kind of work.
I’ve outlined the process of how to find the right provider above.
Plan on consulting with six providers before you choose one.
It is totally fair game to go back and reconsult with someone if you still have questions or are uncertain.
When in doubt, slow down and schedule more consultations.
Do not schedule surgery after one consultation.
Don’t assume people are good at what they do because because they have reviews or certifications.Best,
Mats Hagstrom MD

Botched breasts, best route? (Photo)

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