Implant Replacement - 3 Weeks Post Op and Unhappy

I had surgery to replace saline implants overs with smooth gel implants over. Surgeon recommended sub musc placement of implants with lift. I'm averse to scars because of keloids in past so really wanted to avoid a lift. Surgeon agreed to gel implants in same pocket without lift advising this was not optimal and I would likely need a lift in time. I was mostly concerned with rippling but still have significant rippling :( Now I'm ready for a lift :\ How should I proceed?

Doctor Answers 14

Unhappy Early

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It is way to early to make any decision regarding further surgery. I feel your surgeon advised you correctly. I am sorry you are unhappy. Are you implants on top of the muscle or subpectoral. My preference would to place your implants under the muscle but I would wait a minimum of three months. A lift could be done at the same time. This operation does have higher risks and your surgeons can certainly help you to make an informed incision.

Indianapolis Plastic Surgeon

Keloids and Breast Augmentation

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I would wait about 2-3 months and let the swelling to completely resolve and the breast to settle.  Before you proceed you and your surgeon should talk about how to manage the potential for keloid formation including not performing the lift and removal of the implants if the risk of the keloid formation is great.  

Dr. ES

Re-operating too soon is not advisable.

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Three weeks after any operation is too soon for any patient to be making a final assessment. Your breasts will continue to change shape over the next few months, so be patient. Further, the amount of and degree of scar tissue that you likely have at three weeks precludes an optimal operation. Unless there is a real emergency, it is better to wait at least 3-6 months for any other procedure on your breasts.

Kevin Brenner, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 23 reviews

Removal and Replacement of Implants

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I agree that the best treatment for your recurrent rippling is a new submuscular pocket with lift. Rippling is a function of thin overlying coverage, and to provide adequate coverage, a submuscular pocket is indicated. Skin tightening is typically required so that it isn't loose and saggy overlying this much higher pocket. Yes, scars are the trade-off, but they fade with time and hide well in bras and swimsuits. If there were a better way to do this without the scars, believe me, we would be doing it. Most women get saggy over time and with pregnancy and breast lift with its associated scars is usually well accepted. Most patients heal fine over time, however there is always a risk of visible, hypertrophic, or keloid scars. 

Wait three to four months

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I suggest you wait at least three to four months before you assess your results. At that time, then you can consider subsequent surgery.

Need a lift after implants

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Discuss your issues with your surgeon.  If you need a lift and he recommended it in the first place, you will more than likely have to pay for the surgery.  You will probably have to wait a few months to insure proper healing from your initial surgery.

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

Listen to your doctor

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Sometimes we have our own ideas of how things should be done and need a doctor who is willing to say no to you.  It sounds like the submuscular placement would be better as there is more tissue between the implant and the skin thereby diminishing the wrinkling.  The lift will help to tighten the skin and raise the nipple to a better height.  Go back and discuss this problem with your doctor.  Thjere may be ways to minimize the scars by doing a periareolar or a lollipop type lift.   If need be, get a second opinion as well.  Good luck in the future.

You need a breast lift

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Sounds as though your two biggest issues are rippling of your implants and droopiness of the breasts. This can be corrected with a mastopexy (breast lift) and conversion to a submuscular pocket. Visit with your plastic surgeon to determine the optimal timing for this.

Best of luck.

Breast lift staged after augmentation is ideal sequence

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Your situation is ideal from the perspective of predictable results with a breast lift- the procedures are best 'staged' with augmentation preceding a lift. In most cases, patients don't want to deal with two separate operations, and they lift and augment are combined. That's okay, but I think results are most predictable when a lift is done after an augmentation as a separate procedure. This is my opinion- this is a hotly debated subject amongst plastic surgeons.

If you have implant rippling, the recommendation is typically a silicone implant in the sub-muscular position. Fat grafting can help conceal some rippling. Acellular dermis (Strattice) can help, but its expensive.

Go back to your plastic surgeon and explain your concerns.

Breast lift following implant remove and replacement

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IT sounds as if you  are particularly thin and I am not sure that putting the implants under the muscle will significantly alleviate the rippling. The use of ADM may be an option to mask rippling over the inferolateral aspects of the implant. If you have rippling in the upper portions of the breast, you will have no choice but to try under the muscle placement. Your choice of lift depends on the extent of ptosis.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 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.