Would you advise for revision surgery? (Photo)

I'm 3 mos post op and had 213 cc mod+ implants. I noticed from day 1 that my left implant was lower. I am trying to weigh out the pros and cons of revision surgery. My right breast is still numb and I'm worried about numbness in the left if I fix it. I'm also worried about flat spots on the fold since it will be lifted with sutures. I'm worried about the pain from surgery. I've posted my 3 mo post op pics. Would you advise on getting a revision? Do the pros outweigh some possible complications?

Doctor Answers 5

How to repair bottoming out after breast augmentation.

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Bottoming out is one of the most common reasons for early re-operation after breast augmentation.  Bottoming out occurs early after breast augmentation (usually within the first 3 months) over 95% of the time in my experience. The frequency (or rate) of bottoming out increases with the overall size (interpret this as weight) of the implant, but bottoming out can even occur with any size.

Repairing a capsule that has bottomed out requires permanent sutures and/or mesh to help close off the space and support the implant. I try not to use mesh because the mesh can create unnatural folds in the deep tissue that can be palpable in some patients.  The discomfort after repairing a bottomed out implant (capsulorrhaphy) is typically more than for the initial operation for my patients because my typical post-op recovery after the initial operation is usually fairly easy.  Other physicians may find the discomfort to be the same or less, depending on the typical recovery their patients experience in their clinics.  I tell my patients that it will feel like bruised ribs and to anticipate taking pain medication for about 7 days.

I typically also support the repair with an underwire bra to help relieve pressure against the sutures so that the scar tissue has a better chance of healing.

Sensory abnormalities are usually less common with repositioning surgeries than the initial surgery, but it is important for you to recognize that as a possibility.

Revisions are only done if you want it

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as many live with asymmetries such as yours without concern or problems.  If you want perfection, you may need a revision but if your lower side is good to you, focus on supporting it and try pushing your other side down to better match i t.  If you like the higher side, then a revision will be needed.

Revision after Bam?

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Hi upset,

  It is a little early to ask for a breast augmentation revision at this point. The other breast may also fall in a few months so I would still give yourself some time to heal. You might try to tighten up your bra strap on the left and loosen it a bit on the right.

  I do not think that the pain will be nearly as great as it was for the first procedure if you do need to have a revision in the next few months. It is possible to lose feeling on your nipple if you have a revision , although the risk is small. The procedure for a revision, if necessary , will be far less extensive. Give yourself a little bit more time to heal. i would advise that you discuss your concerns with your surgeon so that he/she knows how you are feeling at this time about your result.


Dr. Christine Rodgers

Breast implant bottoming out and what to do about it #plasticsurgery

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Based on your photo, it appears that your left breast implant has 'bottomed out' - in other words, the supportive infra-mammary fold on that side has failed and the implant has drifted down. This can be a challenginf problem to fix. I believe the most efficient and reliable way to deal with bottoming out is to reconstruct an infra-mammary fold and support the implant with a Strattice 'internal bra'. 

Would you advise for revision surgery?

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 I am sorry to hear about your concerns after breast augmentation. Although it's little too early to evaluate the outcome of this on the existing breast asymmetry, I would predict that you will end up with a considerable degree of breast asymmetry in the long-term. 

 I think that you are wise in considering the pros/cons associated with revisionary breast surgery.  Generally speaking, I advise patients to carefully consider their degree of concern with the outcome of the initial breast surgery and weigh these concerns against the potential risks/complications associated with the planned revisionary breast surgery.   For example, if the patient is concerned about her breast appearance on a daily or frequent basis, it is likely that revisionary surgery will be helpful when it comes to improving her quality of life.  On the other hand, if the patient's degree of concern seems minor and/or she is  infrequently concerned about the areas of concern, I would recommend against revisionary  breast surgery.

 In your case, specifically, based on the asymmetry present and your concerns, I think that will benefit from revisionary breast surgery. In my opinion, a well executed revisionary operation (involving capsulorraphy) will help improve your symmetry and satisfaction considerably.

 Again, in my opinion, the pros out weigh the potential downsides assuming you select your plastic surgeon carefully. Make sure that he/she has a significant/demonstrable experience helping patients with this type of revisionary breast surgery. Best wishes.

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.