I am now at 3 weeks post op & my PS is not pleased w/the way my breast tissue seems to be "falling over the implant".

Question

20 days ago I had a ba:360cc, textured,anatomical,cogel. I am now at 3 weeks & my PS is not pleased w/the way my breast tissue seems to be "falling over the implant". The PS would like to see me again in 6 weeks claiming it is "possible" that I would need a vertical breast lift!I am very upset that this is being sprung on me AFTER the fact as no lift has ever been mentioned before.I am not sure what to make of this as it is not a complication I have heard of!Any thoughts?

Richard H. Tholen, MD, FACS · Answer

I just responded to your question in another posting, but you provided some useful additional information here. Textured implants often do not drop (as much or sometimes at all) as time goes by and healing and scar softening occur, so if you have excessive drooping now, it may be more likely that you will need additional surgery in the form of a breast lift.

	I am answering this post in the hopes of advising more than one consultation with other board-certified plastic surgeons. Although vertical breast lifts work nicely for select patients (and seem to be "all the rage" in some plastic surgical circles these days), I am not a fan of the idea that vertical lifts are for "everyone" in need of a breast lift. My biggest concern is that vertical lifts correct the breast skin laxity in only one dimension. That is why the Wise-pattern (anchor) mastopexy is still the most common breast lift and breast reduction technique in use by the majority of plastic surgeons--this incision pattern corrects the skin looseness in more than one dimension, giving a much better breast shape (albeit with the presence of scars in your inframammary creases--usually well-hidden and minimally-visible). I fail to see the big advantage in the vertical lift when the vertical scar is irregular and too long, often crossing the crease into the chest area (below your swimsuit top!), and when this lift fails to address the skin looseness in the other direction!

	Of course, a personal examination (or photographs) would provide much more information upon which to base a recommendation, but again, be patient with the healing process before jumping to re-operation, and consider several opinions to avoid the scenario of my patient in the link below!

Steven Wallach, MD · Answer

I think I just answered your question in a different post.  But if your breasts are falling over your implants,. then they probably needed to be lifted.

Peter E. Johnson, MD · Answer

A photo would help, though one can imagine with an anatomic highly cohesive textured breast implant, under the muscle in a breast with a degree of loose skin the effect is is one of a 'breast' on a breast. The real breast is free to fall over the surface of the implant. What we mean is the cohesive gel implant is like a gum drop, stiff, and textured so no movement or flow with the breast, and the breast proper is free to move over the surface of the chest as before the implant was placed, no marriage between the two. Much to consider though a lift may only partly solve the problem. Consider another opinion and perhaps a lower profile smooth gel, not cohesive, over the muscle to lift and blend with the breast.

	Best of luck,

	peterejohnsonmd

Stephen Delia, MD · Answer

I agree with my colleagues, it is difficult to advise in the absence of more specific information. Also , keep in mind, particularly with anatomical implants, if the implants are "riding high" , it may sometimes accentuate the appearance of sagging or ptosis. You may want to give it more time ,do more massage on the upper pole of your breasts to possibly help the implants come down a bit.

Darryl J. Blinski, MD · Answer

Agree with Dr Rand. Post before and after photos please if possible. I bet you needed a lift from the get go.

Mahmood Kara, MD - Account Suspended · Answer

Hello. 
Thank you for your inquiry and congratulations on your surgery! 
It is important to have an in-person medical assessment regarding this issue as it is difficult to determine virtually without any photos.
Continue to update your doctor in the matter and follow their post-op protocol.
It is important to get cleared by your doctor before engaging in specific physical activity before the 3 month healing period has ended as the healing stage is crucial for healthy results.
It generally takes around 6 months to a year to see your final results. Your tissues will take time to relax and allow your implants to "Drop and Fluff" settling into place.
Our tips for recovery following breast augmentation are to wear a supportive sports bra for 3 months post-operative and refrain from lifting anything heavier than 10 lbs for 3 weeks as we don't want any strain at your incision sites. Make sure to keep the area of your stitches clean by cleansing with hydrogen peroxide daily. Showering is encouraged! But, no sitting in water for 2 weeks following surgery (no baths, hot tubs, pools etc.). 
Please note that this response does not substitute patient-doctor relationship.
We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.
During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery.
We invite you to come in to discuss your options more thoroughly.  Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!
M.Kara,MD,FRCSC (27+ years experience)
- Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind

Lori H. Saltz, MD (retired) · Answer

It is impossible to give you an accurate answer without a photograph. In general I would say that if your breast is "falling over the implant" three weeks after surgery you may have been one of those who would have benefited from a lift in the first place. Breast aumentations do not lift the breasts. There are many shades of sagging and exactly when to draw the line and do a lift can sometimes be a difficult decision. I have found that if the question even comes to mind on examination I am usually going to get a better result doing mastopexies than not doing them. I understand that it can be an upsetting thing to hear about after you have had surgery. Wait a few more weeks and see what happens and what your surgeon says. Don't rush. Breasts change a lot in the first few months after surgery and your surgeon was wise to put off the decision for at least another six weeks. Before you decide on more surgery get an opinion from another plastic surgeon. If possible take "before" photos.

Richard P. Rand, MD, FACS (retired) · Answer

Of course without a photo we are limited in what we can say here and this is not to be a substitute for a consultation.  A lift is "needed" what the nipple is down near, is at, or below the crease below the breast or when it points down.  The implants will not lift you, they just make you bigger.

	I always tell my patients when they "need" a lift to get the best looking result even if it means the scars and the extra cost they don't want to have.  I personally would be very uncomfortable telling someone after I had augmented them that they need a lift as if I didn't know it already.  The problem is that some doctors will tell you what they think you want to hear and never mention the lift because of course no patient wants one.  Also, some doctors just find a more matronly droopy breast to be "natural" and they assume that you wouldn't want a lift so thay don't mention it.

	Either way, if you do need a lift, the final result will not look any worse by having staged it and some would argue that the process is actually a little safer by separating the lift from the implant surgery.

I am now at 3 weeks post op & my PS is not pleased w/the way my breast tissue seems to be "falling over the implant".

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