Implant separate from breast - will a lift help? (Photos)

Question

I’ve had a lift in 2023, then implants and another lift 2024, then another lift in April of this year. I don’t think k it was aggressive enough any of the times but now I’m going next Thursday for another revision and my surgeon says it won’t make any difference and they can’t do an aggressive lift because they’re worried about the tissue and nipple

Daniel Barrett, MD · Answer

Dear Anonymous 2222,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ira H. Rex III, MD · Answer

Your surgeon understands best about the blood flow to the nipple and areola, which are at the end of the circulation and most at risk for poor healing.  It seems important that you go with his recommendations.  Often the circulation improves over the years and may be more aggressive surgery could be considered at that point.  Otherwise, it seems you are nipples are in good position and you can enjoy your present results for a while.  Good luck with things.

Donovan Rosas, MD · Answer

Revisionary surgery is always more challenging and marked by higher complication rates and lower likelihood of success.

In the setting of multiple revisions, one has to not only consider the likelihood of achieving the desired outcome but also the potential for healing compromise. Greater scarring compromises vascularity. Compromised vascularity can jeopardize healing.

I typically encourage patients to temper expectations for revisionary surgery. The best chance to achieve a particular outcome is the first time. Each unsatisfactory revision makes the odds of subsequent success lower.

With regards to your specific question, a third revision is less about technique and more about tissues quality/scarring. Conservative is the operative word to avoid unplanned complications.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Guray Yesiladali, MD, FEBOPRAS · Answer

After several breast lift procedures the challenge often shifts from technique to tissue quality. Each surgery changes the skin’s blood supply and elasticity so the surgeon must balance how much lifting can be done safely without compromising nipple circulation or wound healing.
If your surgeon feels a more aggressive lift could endanger the tissue that caution is not about being conservative, it is about protecting long-term results and your health. Sometimes the solution is not more lifting but restructuring internal support (for example with internal suturing or mesh) or adjusting implant size or placement to reduce downward pull on the breast.
A detailed examination of your skin thickness, implant weight and existing scar pattern is essential before planning another revision. At this stage focusing on stability and preservation is just as important as aesthetic change.
I know repeated surgery can be discouraging but each step offers new information about how your tissues respond. With a careful plan comfort and safety can still guide you toward a result that feels balanced and lasting.
Güray Yeşiladalı, MD

Mark Eberbach, MD · Answer

First what are you lifting?  What don’t you like? Want do you want for a result? Lifts move the nipple, not the whole breast!

Your nipples are fine. Don’t move them.

The shape of your lower pole can be improved a bit. Certainly not a “lift” candidate.

Camille Cash, MD · Answer

There is risk involved when performing a breast lift multiple times.  With several revisions there is a higher risk of complications such as necrosis which makes an aggressive approach ill advised. If you are a candidate you may want to consider smaller implants, no implants, and/or adding bioabsorbable mesh for more support.  I've included a video about mesh that I hope you find helpful.

Rafael Ramos Vecchio, MD · Answer

Hello! Thanks for sharing. What you are seeing is the result of your natural tissue gravity pull with an implant that is fixed in a static position, likely under the muscle. We call this waterfall deformity. Yes, after 3 lifts, the risk of compromising the blood flow to the nipple/areola goes up if they aim to do an aggressive lift. If the concern is more about the vertical distance between the implant and your breast tissue, it would be worth it having a discussion about changing the plane in which the implant sits. An implant that sits in front of the muscle tends to age more naturally and descend in closer proximity with the rest of the breast tissue. The shape of the breast tissue can benefit from extra refinement but understanding there might be limits due to your surgical history. 
Hope this helps!
Best,
Rafael Ramos Vecchio MDPlastic and Reconstructive SurgeonCoral Gables, FL

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