8 Months Post-op BA: 32DD to 32 G/H: I Want Them to Look as They Did 1 Month Post-op - What Should I Do? (Photo)

I was a deflated 32DD preop & was advised 2have 500 cc smooth mentor silicone placed below muscle 2obtain "Selma Hyack breasts" I requested. I asked about lift & was told I did not need one. Now my breasts look terrible & I'm told by different PS that my implants were NOT EVEN PUT UNDER MUSCLE which is what he was SUPPOSED to do! I was told I would need explantation & lift then wait for 3 mo before re implant! One dr responded w/ ultimate breast lift which sounds amazing! Want PERKY DD not G/H

Doctor Answers 11

Saggy breasts

I would suggest that a full lift and possibly the use of an ADM or internal Seri tissue graft to strengthen the internal support may be very useful.  By the way, I would certainly believe that downsizing the implants should also be done to have a chance to give you a better result.

Good luck to you.

Frank Rieger M.D.  Tampa Plastic Siurgeon

8 Months Post-op BA: 32DD to 32 G/H: I Want Them to Look as They Did 1 Month Post-op - What Should I Do?

Thank you for the question and pictures. Some your photographs, revisionary breast surgery including mastopexy surgery will be helpful.   I am hopeful that the remainder of thisresponse will be helpful to you and patients considering augmentation/lifting surgery in the future.

 Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time.  This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation. I would say that, in most communities,  anesthesia and surgery facility fees (minimally) are patient responsibility,  when returning to the operating room for revisionary breast surgery.

 Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.

To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.

Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery.

I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. 

The use of the tailor tacking technique is very helpful.  Breast lifting involves removal of skin ( and tightening of the breast skin envelope)  while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate  size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.  Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.

 Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts.  Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.

For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness).  It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation.  The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery,  Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia,  lateral displacement etc).

 Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.

Given the complexity  of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately.

For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or  whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).

Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks  are greater with a 1 stage  procedure and the patient does have a higher  likelihood of needing revisionary surgery.

Having discussed some of the downsides  and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.

 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.

 The attached link may also be helpful.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

8 Months Post-op BA: 32DD to 32 G/H: I Want Them to Look as They Did 1 Month Post-op - What Should I Do?

Revisional surgery with reconstruction using ACDM to act as a mesh internally.The weight of the very large implants has defended the breasts inferiorly.///

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Breast sag after augmentation

Thank you for your question and photos.  Unfortunately your skin has stretched significantly after your previous breast augmentation.  This is not uncommon, especially when very large implants are used.  500cc implants are quite big and gravity will work on them, pulling them down.  Your genetic make-up may also predispose you to have stretchy skin, which only compounds the issue.  What you will need to achieve your early post-op pictures is a breast lift and decreasing the size of the implant will put you at less risk for this to happen again in the future. 
Best of luck to you.

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 36 reviews

Implants and tissues

The early post-ops do look very nice, and it seems that your tissues can not handle such large implants. You may want to consider smaller implants and a revision lift.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Sagging after surgery

I can see what you liked with the early result, and what you don't like now. The fact that these looked ok at the 1-2 month post-op to me justifies the decision not to do a lift. Looking at the preop photos, the need for a lift seems borderline. 

What happened since over the past six months may or may not have been predictable. But is certainly is a marker of the fact that your breast tissue could not support an implant of that size.  Above or below the muscle, it is not likely that the course would have been different. 

To me, that means two things should be considered--smaller implants, and dermal support with an acellular dermal matrix, such as Strattice. If the implant is above the muscle, it should be moved to under the muscle to use the Strattice. My concern that a lift alone will give you the appearance you liked at 1-2 months, but only again and 1-2 months, after which time the skin of the breast will continue to stretch and sag. This is not a simple problem

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Breasts settling after 8 months

You have  large implants in place and some settling is to be expected. Short term you may consider a mastopexy and supportive bra. Long term you may have to reduce implant size and need a mastopexy. Gravity is a strong force acting on those large implants and your skin can only do so much. Thanks for your question.

Gregory Pisarski, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 12 reviews

Revision breast augmentation for ptosis

If you like your current breast volume (in a bra), then you may consider just having a mastopexy (breast lift) performed without making any adjustment to the implant or the implant pocket.  Remember, a breast lift will shorten the appearance of your breast and even though only a few ounces of skin are removed, the breast will look smaller than it looks today and it may even fit differently enough in a bra that you end up downsizing the bra a bit.

If you feel that your overall size is too big (and a 500cc implant is generous), then you may want to downsize your implant and get a lift which can possibly be done at the same surgery.

Your implants may be in a dual plane location meaning that part of the implant (up top) has very good muscle coverage but that the lower aspect of your breast tissue is in contact with the implant.  If this is the case, you may not need any adjustment in the location of the implant related to the muscle.  Your operative report may give you or another surgeon more information if you do not wish further consultation with your original surgeon. 

Hope this information helps!

Jennifer Lauren Crawford, MD
Austin Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast Lift

At this point, assuming the picture on the far left is your current state, I would recommend a breast lift. 500cc implants are also quite heavy so you might want to consider converting to a smaller implant.

Lee E. Corbett, MD
Louisville Plastic Surgeon
4.8 out of 5 stars 25 reviews

Breast implants don't correct need for breast lift

Thank you for your question.

I wish I could say that this is the first time that I have heard this story.  Many women come to the office who have had large, cumbersome implants placed elsewhere instead of a lift with a proportional implant.

Breast implants are no substitute when a lift is needed. Otherwise, the implants without support fall into the skin envelope and you get what one of my patients described as a water balloon in a sock.

To fix this, you will certainly need a breast lift and likely have your breast implants downsized at the same time.  Smaller, perkier breasts with a nice shape is much better than large droopy breasts. I don't think that you need explanted for 3 months.

To be sure what is best for you, see two or more board certified plastic surgeons. I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 183 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.