4 years post op - breasts are sagging. How can this be fixed? (Photos)

Thank you for your pictures and questions. Let me first tell you this is not a complication. It is an expected outcome of surgery. But it can be fixed in the right hands with the right plan. Without reveiwing your operative reports or examining you, it is hard to say for sure, but what this looks like to me is the expected outcome of a surgical plan with lack of long term thinking about soft tissue support. A heavy glandular breast with signs of already poor soft tissue support was reduced and an implant was placed. Not sure of implant details (CC? over/under muscle? profile?) but that new implant started immediately putting strain on the soft tissue envelope (superior pedicle? inferior pedicle?) and without support, that tissue did exactly what I would expect it to do over time which is give way to the implant, stretching the lower pole of the breast and allowing the implant to continue to sink deeper and deeper on the chest until you are at where you are today. The correction for this would be a revision (possible with newer more cohesive gel implants), revision of the lift to reduce the stretched tissue, and placement of soft tissue support (I use GallFLEX for this). This would restore things back to a more youthful position and maintain them there for a longer period over the future. Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Your implants took your soft tissue envelope for a ride and dragged them down. The fix, unfortunately, is more than just tightening up the implant pockets and reinforcing with resorbable mesh; you'll need another breast lift. When done correctly, your risk of recurrence would be very low.

In your pre-op photograph, your breasts were quite low. At that time, implants were probably not necessary but what was more important was the lift. Unfortunately, you had a vertical lift technique that only lifts the areola but not the breast tissue. At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.