Does the Breast Augmentation Need Some Kind of Revision? (photo)

I am now about 6 months post op from a breast lift and augmentation. My left breast is fuller and sits a little higher than the right. I knew i would have some scarring from the lift and I was prepared for the vertical line, but is all that black scarring common? I wasn't expecting that at all. I had a tummy tuck a few years ago and you can barely see the scar at all. Am i being too paranoid or does this look bad?

Doctor Answers 10


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In my professional opinion it looks like you have great looking results. You didn’t mention why you thought you needed a revision? You can use scar therapy to help improve your scars if that bothers you.



Beverly Hills Plastic Surgeon

Breast aug revision?

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Your surgeon has done you right! What a beautiful result you have gotten. Breast augmentation and a lift procedure at the same time in my opinion is one of the hardest operations we have to perform. It is hard because you are changing so many variables at one time. You are changing the size of the breast, the position of the breast on the chest wall, the position of the nipple and areola, the shape of the breast and on and on.... Because of that it is nearly impossible to make two breasts exactly the same. You will always have some subtle asymmetry like you describe, but then no two breasts are ever the same are they????? I tell my patients that doing that procedure in one operation is possible as you can see, and you can have a great outcome. Being that said I tell them to prepare that this is a two operation procedure because the need for revision is so high with this surgery. So number one, you look awesome and should be very happy. Number two, that dark skin is clearly the pigment from your previous very large areolas. I inform my patients with areolas as large as yours that this will happen 100% of the time. You do not have any problems with your scar, it is merely the technique that is used for the Mastopexy does not allow for all of that skin to be removed at the first operation without possibly harming the outcome. So, I tell all of my patients with larger areolas that they may have some residual pigment along the vertical scar as you do, and that is something I often will remove in the office under local. Sometimes in one session and many times in a few sessions. It is the only way to get rid of that dark color. It has nothing to do with your scar. Go see your surgeon and thank him or her for doing a great job, and then ask if they can take that dark skin off for you.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Does the Breast Augmentation Need Some Kind of Revision?

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Thanks for the question and for posting excellent photos.

I find the overall outcome is very good. What seems an appropriate issue is the pigment along the vertical scar. This is not bad scarring, and is not comparable to the scar from you tummy tuck. 

This is residual pigment from your areolae. Before surgery, your areolae were so large that the patterns we use to redrape the skin had to include some of the pigmented skin--it was not possible to remove it all and still have enough skin to close the incisions around the implant. Now, however, six months later, the skin has stretched and it should be possible to remove some or all of the areolar skin (probably all on the left side), probably under local anesthesia. The right side might take two tries. I don't think you are being paranoid or unreasonable in wanting to make your incisions less noticeable.

Thanks and best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Does the Breast Augmentation Need Some Kind of Revision?

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Great question and excellent posting of the photos! This demonstrates a poor informed consent issue. In your before photos you have very large areolae. Thus the lift technique has left a residual areolar dark pigmented areas in the vertical scar. After more healing an attempted scar revision to try and eliminate this residual areolar pigment can be attempted. Unfortunately you where not informed in your pre operative discussion of this possibility. 

Residual areola is present adjacent to the vertical scars!

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Your surgeon did a nice job and has given you a nice shape and precisely-closed incisions leading to good scars. But your large areolas pre-operatively led your surgeon to make the judgement that s/he could not remove the excess areola pigmentation without removal of skin needed for your best breast shape.

Now that things are well-healed, revision can be performed and the remaining darker-pigmented skin removed. Costs for touch-up or revisionary surgery should have been discussed prior to your first operation, but if not, this discussion is certainly needed now.

Improvement in position, fullness, and implant position can be made by further adjustment in your lift incisions, implant pocket, and/or implant size. The more changes needed/requested, the more involved the surgical revision will be (and associated costs). Review this with your surgeon and have your questions answered. For several examples of my breast lift plus augmentation patients (including one with 3 previous operations by 2 other surgeons elsewhere), click on the web reference link below. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

“Dark Scarring” after Breast Augmentation/Mastopexy?

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Thank you for the question and pictures.

Unless you have some concerns that are not visible on your pictures, I think you should leave your breasts alone (from the surgical standpoint).  The “black scarring” that you see is residual dark areola skin (left over from your original large areola size).  This pigment is still present because it is not possible to remove it completely during the breast augmentation/mastopexy operation, without distorting the breasts.

 Overall, you should be aware that your plastic surgeon has done a very nice job for you.

Best wishes.

Breast scarring in black patient

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Six months is not full healing so I would give it more time for the tissue to relax and the scarring to possibly fade. Scar revision can be performed at a later date but, in the initial operation, the goals of the lift/augment have been fulfilled.

Pigment and breast appearance

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The pigment is most likely from the large areolas that you had. As things relax, this tissue may be able to be removed.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Revision of augment mastopexy scar

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Agree you have a very nice result and that the dark skin is from your areolas.  Wait a few more months to let your skin relax more and then you could consider revising the scar to remove the remaining pigmented skin.  This could be easily done under local anesthesia if it bothers you.

Leonard T. Yu, MD
Maui Plastic Surgeon

Is any revision needed?

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Thank you for posting your before and after photos.  I do think you have a pretty good result.  The reason why you have pigmentation along your incision is this:  if you look at your before photo, you had very large areolas.   It is likely that some of that darker areolar pigment remained along your incision.  hence the darker color along your vertical scar.   You may have some minor asymmetries.  You likely had these before your surgery.  Remember, breast procedures can't produce identical twins - but close sisters.     if you do want to explore a scar revision, I would waist at least 8 months. You look great. Enjoy your results. Dr. Basu Houston, TX

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