29 Years Old, No Kids - Much Needed Breast Revision - Bal Harbour, FL

Hi everyone!

This website has been so helpful to me during my BA journey. I wanted to also share my experience and give back to the community. I had my primary breast augmentation done a while ago. Though I went to one of the best doctors available in the country I was working in at the time (Seoul, South Korea, the Land of Plastic Surgery lol) - I experienced bottoming out and lateral displacement shortly after surgery. At the time we didn't know what happened, if it was from me healing poorly or from surgeon error. I was told to keep wearing my surgical bra 24/7 for 3 months to prevent it from getting worse. It helped at first, but unfortunately it got worse over time and I needed a revision since the dreaded double bubble was forming...

I have relocated back to the US at the beginning of this year and I started researching on surgeons. I have spoken to a lot of surgeons and I narrowed it down to Dr. Krau and Dr. Revis in Florida, Dr. Ciaravino in Houston, Dr. Pousti in San Diego and Dr. Pfeifer in New York City.

Since I currently live New York, I was inclined to go with Dr. Pfeifer for convenience and she has an excellent reputation for revising difficult cases but after reviewing a lot of her before and after photos, I am not sure if we have the same sense of aesthetics. Her results seems to be more natural looking while I am hoping for a lot of upper pole fullness :)

All of the other surgeons also have excellent reputations and have lots of experience with revisions as well and seems to do the high and full look that I love but I am not sure if their methodology would work for me. I have consulted with all of them through email and phone calls. I am very athletic and Dr. Revis, Dr. Ciaravino and Dr. Pousti wanted to use permanent sutures to do an "internal bra" to hold the implants in place and keep it from bottoming out/laterally displacing. It gets attached to the rib muscles and I've read some mixed reviews on that technique. It works amazing for a lot of ladies and they never had a problem afterwards, but for some they experience pain and discomfort - like an annoying nagging pain in their ribs that won't go away. Speaking to some ladies on a forum, some of them have ripped internal stitches as well doing upper body activity. Also, the idea that stitches holding me together forever doesn't sit well with me as well. But I am no doctor, this is just a personal preference of mine.

When I spoke with Dr. Krau - he said he prefers to use a thermal capsulorrhaphy technique. When heat is applied, the implant pocket will shrink up without the need for internal sutures. He mentioned that using internal sutures for fixing an implant pocket is like stitching your ear lobe to the back of your head. Yes, it will hold and sometimes it will hold forever but you are stitching two smooth surfaces together and they won't bond and form scar tissue so it will naturally fuse together in the long run. He was also the only surgeon that pointed out I had lateral displacement from the photos I've sent for the email consultations. He also perfers to use GalaFLEX as the ADM material instead of Strattice. Strattice has been around for a long time and is proven to be reliable but you need drains afterwards for the fluid buildup. Also the mesh in the GalaFLEX is also more porous so it encourages both collagen and capillary formation so when it dissolves after 1 year - 1 1/2 years, so you have strong scar tissue to hold up the implants after the mesh dissolves since it's made from a similar material as dissolvable stitches.

After much consideration I decided to go with Dr. Krau for my revision.

When I came back to the US, I was very excited since we have great surgeons here and breast augmentations are very common so most surgeons have a lot of experience. But I quickly learned that revisions are much more complicated than a primary BA. Unless you are going back to your original surgeon for a revision, it is a surprise for the new surgeon when they perform the revision. Different surgeons have different techniques. For the revision have to figure out if it's a problem was caused by surgeon error, poor healing or trauma. How the implants changed skin tightness, stretched the ligaments (yes breasts have ligaments too - who knew!), and amount of breast tissue coverage will also be a factor as well.

I consulted with some surgeons in the NY/Tri-State area and wasn't very impressed by the before and after photos or the surgeon's experience with revisions. So I started researching more on surgeons have lots of experience with revisions and managed to get a short list of a few who had very good reputations. I rather travel in hopes of having a successful revision. Since I have spoken to quite a few ladies who needed more revisions than anticipated due to picking a surgeon that projected confidence but delivered poor results.

So during my consultations with surgeons around the country hoping to find the best one for my case, I have reached out to Dr. Krau's office via email with photos and LOTS of questions and after a few hours, Cristina his office manager got back to me after she discussed with Dr. Krau. After reviewing his assessment and answers - I had more questions and reached out again via email. I got a reply from Cristina saying that Dr. Krau would like to speak with me directly and provided a number to reach him directly.

During our conversation, he said that I am bottoming out on both sides, worse on the left than the right, since a double bubble was forming on the left side. I was laterally displacing on the left side, and he pointed out that he sees there is more muscle attachment to my sternum since I had sort of a flat spot there, so due to that muscle not being released properly - it is forcing the implant to go laterally, hence the displacement. For my right side, my first surgeon didn't release my lateral side enough - so my implant was shifted over my midline and my nipple looked off center. On top of that, both my IMF scars are hypertrophic, which can be caused by the inplant weight from bottoming out sitting on the incision. So his game plan was to do thermal capsulorrhaphy, with 1 piece of GalaFLEX on each side to support my implants and to fix the lateral displacement and midline displacement. Jeez... if I didn't have lateral displacement on my left side, there was a good chance I could have have developed symmastia. Plus he will need to open up my implant pockets up higher so the implants have space to move up to and he will use my existing IMF incision to do the revision.

After speaking with him on the phone, I had a very strong feeling that he would be the surgeon I will pick for my revision. He was very detailed in his explanations and never talked down to me or felt annoyed that I wanted to know everything that needed to be done and I can be long winded...

After doing some more research and consulting with the other surgeons again, I decided to go with Dr. Krau and placed my deposit for surgery in April of 2016 and set my surgery date for September 29, 2016! Working with Cristina is great, she setup my pre-op appointment to meet with Dr. Krau on September 28th, emailed me all of the instructions for pre-op, and a request for blood work that needs to be done within a 30 day time frame prior to the surgery.

My total for revision was $8000, it included everything from the surgeon's fee, implant exchange, anesthesiologist fee and 2 pieces of GalaFLEX. Compared to the other surgeons, his fee wasn't the cheapest quote I got - Dr. Ciaravino quoted me less with no ADM material, but both Dr. Pousti and Dr. Revis wanted more for the revision - and their quotes do not include any ADM material like GalaFLEX, Strattice, or Seri Mesh either. I picked Dr. Krau based on gut feeling and his technique mentioned.

Since I was also traveling from out of town by myself, I needed to hire a nurse to be with me at all times during the first 24 hours and they were very helpful in recommending someone that can help me. She normally works with an agency that specializes in post-op patient care so she has lots of experience and it was much more reasonable to work with her directly than through her agency.

I booked a hotel in the mid-beach area (The Edition Miami) and was planning to use Uber/Lyft to travel back and forth. That worked out great! They usually recommend a few hotels that are reasonably priced and close by to their office for out of town paitents, but I wanted to enjoy Miami Beach as much as I can while I'm there. Being able to sit under an umbrella on a beach watching the waves calmly rolling in with someone constantly attending to your needs was the best thing for recovery.

So with the date set, and trip planned - all there was left to do was wait until it was time to travel.

Wow looking at the pictures was difficult. Both boobs were so low, double bubble was forming and everything was as lopsided.