475cc, 1 year post-op & sit too low and far apart, do I need another revision? (Photos)

Dear Affectionate643233,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

You are missing the fullness of the larger implants, but these fit your frame and tissue much better. Do not go back to the large implants. You do have one breasts that is sagging more on the bottom side. an examination can tell if that is breast tissue or the implant which has dropped. Your lateral pockets could also be tightened to help give a little more upper fullness. If you bottom out again, you need to go smaller.

Based on your nicely posted photos, you need a in person or virtual consultation to fully discuss your options for breast revision surgery. I would use a mesh with possible L-shaped lift to get more symmetry of breast expect to range from $10,000-$20,000 again best of virtual consult with.

To make an assessment regarding the outcome of any plastic surgical procedure, we need to see a proper before and after pictures.
If you’ve had more than one procedure, then we need to see before and after pictures of each of your previous procedures.
To get a proper second opinion consultation, I suggest scheduling those in person consultations with other plastic surgeons in your community.
For in person second opinion consultations come prepared bringing with you a complete set of proper before and after pictures and copies of each of your previous upper reports.
These are all available from your providers office if you request them.
Breast augmentation outcomes are generally based on three variables.
The first variable is the patient’s candidacy for the procedure.
Variables that alter candidacy include breast position on the chest wall, breast shape, breast divergence, etc., etc.
The second variable is implant selection in regards to size shape and type of implant used.
Generally, speaking larger implants tend to increased the chance of undesirable side effects, complications and increased need for revision surgery.
The third Variable is the surgeon ability to put the implant in the correct anatomic location.
Whenever patients have concerns or results are less than ideal we can almost always attribute the outcome to one or more of these variables. Implants that bottom out are usually a result of implant placement.
Using large diameter implants increases a chance of implants bottoming out, but this complication is generally directly related to a technical error.
Surgeons should always maintain integrity of the IMF (infra mammary fold). Violating the IMF leads to implants that bottom out.
Revision surgery to correct bottomed out implants is fairly challenging and not always easy or straightforward.
The procedure is sometimes done using permanent sutures to close the lower part of the pocket and sometimes using mesh or cadaver dermal product can be helpful.
Each provider will have their own way of doing this and skill as well as experience will differ among different providers.
I don’t think it’s possible to give you an accurate assessment and therefore not possible to give you quality recommendations based on limited information.
Either continue following up with your provider or get a proper second opinion consultation.
Best,
Mats Hagstrom MD