Lift revision - what should I ask my surgeon?

Question

9 months post OP. Anchor lift and SSM 310. I’m planning an implant exchange to 405 SSM. I feel like my implants don’t fill out my chest wall and I’m wanting a little more volume. But I already feel like they sit so low with a large gap still in the middle. I hate the look of the skin in the middle and still feel insecure wearing low v neck shirts. I just feel droopy still. I’ve expressed this to my surgeon and he hasn’t really given me and options. Teighten pocket? Mesh? More skin off?

Robert M. Lowen, MD · Answer

Dear Sara,
  I see what you mean and I think you are on the right track with your questions.  It looks first like the breasts could be higher.  If the nipples were higher, it would be important that the nipple to fold distance not be more than 9 cm.  Looks longer than that now, so some reduction of the nipple to fold distance would help elevate the breast mound and get it off the chest.  If you stretched out in the last nine months and are contemplating a revision and a larger implant, I think galatea mesh would be a good choice to hold the breast up.  Filling the upper pole requires a larger implant and in your case it looks like it would be helpful to tighten the skin envelope and perhaps move the nipple/areolas up a couple centimeters

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revision breast surgery.  I believe that your issues extend more than just placing a larger implant.  In your case, I would not only place a larger implant, but modify the pocket with an internal bra procedure-capsulorrhaphy and also revise the mastopexy.  You are an excellent candidate for this.  Best wishes to you.

Ralph M. Rosato, MD · Answer

I understand your concerns. However, there are limitations to what can be done. Discuss your concerns with your surgeon and if they are not helpful consider a second opinion. A physical exam is required before a definitive diagnosis and plan can be outlined. From you photos alone it appears that your breasts have very loose skin. Increasing the size of the implants will help fill out the loose skin, however the heavier implant may cause the breast to stretch out  the bottom of the breast.  The bottom of the breast can be supported with a mesh and this can helpful.  Good Luck

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