What is the simplest fix for waterfall breast deformity? (Photo)

Question

I got implants 9 years ago. The left implant never dropped. The doctor said he would fix it at no charge but it could end up worse. I was afraid it would look worse so just lived with it. In the last year it’s gotten really obvious and I need some help. What is the simplest fix?

Daniel Barrett, MD · Answer

Dear mlwatson1971,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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice almost 30 years and revisionary breast surgery is a large portion my practice.  You definitely have a waterfall deformity.  This is a relatively easy fix with a lift and excision of inferior pole breast tissue.  I fixed this type of deformity many times with excellent results.  Best wishes to you.

Gerald Minniti, MD, FACS · Answer

9 years is a long time and things can happen, including changes to the capsule around the implant, which would affect the nature and position of the implant, as well as soft tissue changes like generalized aging and patient specific loss of soft tissue support. It's clear that the left implant hasn't dropped, but what's not clears is how it might look after capsulectomy, allowing it to sit in a better position. If you are happy with your right breast, then maybe that's all that's necessary, with the exception of changing out the implants. If you would like to see your right breast look better, then a breast lift is in order. A better prognosis could be made with in person examination, which would optimize the surgical plan.

Gary M. Horndeski, MD · Answer

You may have a capsular contracture on the higher breast. This may need to be released. The best way to achieve symmetry is to do both breasts simultaneously. You may benefit from a circumareola approach to reposition the nipple-areola complex as well as pocket revision.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

A front view would have been very helpful. However, you have a capsule which needs to be released to let the implant settle down. Once down, the position of the nipple needs to be checked to see if a lift is needed on that side.

Darryl J. Blinski, MD · Answer

Based on your nicely posted photos, you do have a waterfall deformity with the implants writing high. There is no simple fix you need a second operation with the release of the inferior pole, so the implants fall to the lower pocket, or change the location of the implants to the dual plane location. Best of virtual concert with for options. Recommend ultrasound of breast for implants. Feed range from $8000-$15,000.

Mats Hagstrom, MD (license on probation) · Answer

To make quality assessment regarding the outcome of any plastic surgery procedure, we usually need to see a complete set of proper before and Was nine years ago, but if you have before and after pictures, you should post those and if you don’t, you should try to contact your previous provider and ask them to forward the pictures they took.
While you’re at it, you should also ask them to forward your medical record or at least your operative report which would be helpful for any new provider Taking over your care.
There are two potential issues that I see.
The first is that you have breast ptosis Or droopiness.
This seems slightly worse on the left than on the right.
The second or droopiness.
This seems slightly worse on the left than on the right.
The second potential issue may be the position of your implants.
Most people have the left breast sitting slightly higher on the chest wall than the right side.
For most people the left breast is about half an inch higher than the right side.
This is true for both men and women.
If you put your finger in the IMF (infra mammary fold) on both sides, you’ll see if there is a discrepancy of where your breast sit on your chest wall.
Since the left breast sits higher on the chest wall, it’s normal that the left implant also sits a bit higher in your case. The implant may not be in the correct position.
You’ll need a breast lift and during the surgery the implant position can easily be corrected.
If your implants are nine years old, then most plastic surgeons will probably recommend exchanging your implants for new ones.
This should not be complicated and should be fairly straightforward.
There is some a symmetry of your breast, so you need to accept that there may be a slightly different procedure on the left breast compared to the right breast.
Consult with plastic surgeons in your community to begin the selection process.
During each consultation, ask each provider to open up their portfolio and show you as many before and after pictures as possible of previous patients who had similar issues or body characteristics.
An experienced provider should have access to hundreds or preferably thousands of before, and after pictures to choose from.
If you don’t know where to start the look for plastic surgeons who do a lot of breast cancer, reconstruction it major breast cancer centers at hospitals in your area.
Plastic surgeons who do a lot (preferably at least one to two decades) of breast cancer reconstruction are usually good at all aspects of breast surgery.
Are usually recommend patients have multiple consultations before selecting a provider and generally always recommend having in person consultations, avoiding virtual consultations whenever possible.
Come prepared bringing with you a complete set of proper before and after pictures and a copy of your previous operative report if you can obtain them.
Best,
Mats Hagstrom MD

What is the simplest fix for waterfall breast deformity? (Photo)

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