Breast Augmentation Revision with Lift Concerned About Pocket Placement? (photo)

I had a breast aug in nov 2012 and my doctor did a bad job. Bottoming out? He placed the implant to low. I'm getting a revison. Several other opinions and one dr. told me that he has to sew up part of the pocket because the pocket is so low and he doesn't want the implant to go back down to where it is now which is an extra step he has to do. The doctors are also telling me that I need a full anchor lift. Is that true that the doctor has to sew up the pocket internally to prevent the implant form falling?

Doctor Answers 11

Bottoming out

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is certainly distressing and you will need a revision to fix this.  However the fix can involve many different options.  If you still trust your surgeon, stick with him/her and let them help you through this, especially if he/she has a favorable revision policy.  If the relationship is broken down, find another surgeon and make sure you understand the plan and the revision policy as you may still need more 'work' to achieve the result you desire.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Revision of your breasts in NY

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I agree that a revision is necessary and you certainly will need something done to the pocket internally to raise the implant up. THis can be done with internal sutures, acellular dermis (alloderm/strattics), or a combination of both. This can be complex but this is not as uncommon as you may think, with most of us who do a lot of breast surgery doing several of these exact cases per month. I cannot comment about the need for a lift without seeing you in person. Chose your surgeon wisely!

Breast Augmentation Revision with Lift Concerned About Pocket Placement? (photo)

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Based upon the series of posted photos I agree with your chosen surgeons plan. But over the internet very hard to address if a staged surgery would be a better path to follow. Doing the capsularraphy first than the lifting secondarily. 

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Pocket Revision and Full Lift

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  The pocket revision assessment is hard to make without an inperson exam, as you do not have the classic double bubble deformity and the lower pole of your breast hides the anatomy necessary to render a conclusion.  The assessment of the pocket can only be made with your arms at your side, not above your head.  I am not sure you need a full breast lift, but you would benefit from a vertical or full breast lift.

Revisional breast implant surgery

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Your surgery will be quite complex and you should carefully choose a surgeon who is comfortable with revisional breast surgery.

A breast lift, conversion of your Benelli type procedure to a Wise pattern incision, consideration of the circulation of the nipple (depending on the position of the implants above or below the muscle), correction of the internal pocket, treatment of the double bubble issue are all important things to discuss.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Revision #BreastAugmentation

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From your photos, it does appear that rather than your doctor putting the implants too low, you needed a lift at the initial surgery. Most patients do not want to have a lift, but avoiding the lift when needed often leads to less than ideal results. Few patients appreciate this fact prior to proceeding with surgery. I would recommend a vertical lift to help reposition your breasts properly on the chest. 

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Correcting a low pocket

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Hello. First off it is hard to determine how to correct your breasts based on just one picture. This procedure you are talking about that involves sewing up the pocket is called a capsulorraphy. With capsulorraphy a permanent suture would be placed in the inferior part of the pocket closing it off to the implant.  As I said before, it is hard to determine if this will be enough based off of your picture alone, but if excess skin is also an issue a mastopexy would be needed. I do not recommend an anchor mastopexy because a lollipop mastopexy would be enough with less scaring.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews


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Sometimes plastic surgeons should not give patients what they want instead of what they need and I suspect that you did not want a lift. This is the result. While tightening a pocket is part of a solution, you need a full lift, not the donut procedure.

Revision breast augmentation should give you perkier shape.

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1)  The main mistake was not doing a lift together with your original augmentation.

2)  I think you should NOT have an anchor lift.  You need either a lift with incisions only around your nipples (this will also reduce the size of your areolas) or a lollipop scar breast lift.  Cannot tell which one would be best  from single picture. These techniques are much safer with implants.

3)  The best way to raise the implant pockets so that they stay up is with internal stitches reinforced with a sheet of Alloderm

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Implant and pocket issues

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Sometimes the pocket does need to be sewn up internally along the fold to prevent it from bottoming out. A smaller implant may be appropriate. I can not say what you need without an exam.

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