Internal bra for implant support with revision
Revision breast surgery is always more complicated than it seems and that is one reason why you are hearing different opinions about how to proceed. Your implants appear relatively large and the weight of them likely caused the stretching and sagging. Doing a lift will not add support so an internal bra with a material like Strattice, SERI scaffold, or GalaFLEX mesh would be appropriate to consider in addition to a lift. Most often I would do this in one stage but each situation is different and an in-person consultation is needed to offer specific advice.
The safest technique to correct your problem
would be 2 stages. I recommend a new
technique called Explantation with Ultimate Breast LiftTM. This technique avoids the ugly vertical
scars, maintains nipple sensation and the ability to breast feed. The breasts are reshaped creating upper pole
fullness, elevated higher on the chest wall and more medial to increase your
cleavage. After you have healed from
this, and if you are dissatisfied with the volume you have 2 alternatives, fat
transfer or implants. If implants are
desired, I always recommend small round textured silicone gel implants placed
retro-pectoral since they look and feel more natural, are more stable, less
likely to ripple or have complications needing revision. Unfortunately, you have not told us your bra
size, cup size, your size prior to implants or your implant size. This information would help determine implant
size or fat transfer.
Gary Horndeski, M.D.
Breast augmentation revision
A breast augmentation and a lift, when combined, has a higher risk of complications and need for revision than when these two procedures are performed separately. When you consider that yours is a revision of an augmentation, these risks go up even further. Based on your photos, I would recommend removing your implants and performing the lift as one procedure and replacing your implants under the muscle later (the 2 stage procedure you suggested). I would also suggest that you consider downsizing your implants when they are replaced, as larger implants put more strain on the skin of the lower breast and are more likely to result in skin stretch over time. Having said that, I don't believe there is a right or wrong answer to your question and suspect all three of the surgeons with whom you consulted were giving you their honest opinion. I recommend that you select the board certified plastic surgeon with whom you feel the most comfortable.
Implants above the muscle, consequences
Your pictures are very informative as they exemplify what happens to implants placed above the muscle in breasts that have soft skin. You will need to provide your self with good support so you do not keep sagging.
You will need an in-person examination but it looks like your implants should be placed under the muscle and the breasts lifted. Some of this will depend on what you were like before the implants.
Most patients like to do a one stage procedure. I think you can do a one stage procedure but there is more chance of needing some type of revision than if you did it in two stages. I tell my patients that a 20% chance of needing a revision is better than a 100% chance of doing two procedures.
Make sure you are discussing your situation with a board certified plastic surgeon.
Should I have 2stage lift/ BA w/explant/lift/ w/3-6 mo healing before repeat BA? (photos)
I am sorry to see/hear about the problem you are experiencing. I would agree with you that a two-stage approach (possibly with the use of acellular dermal matrix as well) may be in your best interests. Otherwise, given the reality of poor tissue support ( probably decreased skin elasticity/strength), you are not risk for recurrence of breast implant displacement and breast ptosis. Select your plastic surgeon carefully; make sure that he/she can demonstrate significant experience helping patients in your situation. Best wishes.