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)
Doctor Answers 11
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.
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?
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Breast sag after augmentation
Best of luck to you.
Implants and tissues
Sagging after surgery
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.
Breasts settling after 8 months
Revision breast augmentation for ptosis
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!
Breast implants don't correct need for breast lift
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.
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.