Very unhappy

Since we are limited to 450 characters, I will try to be succinct. I regularly explain to patients, the closer you are to ideal weight, the better the result will be. This patient had a prominent component of internal fat around the organs, making her abdomen round, and her closure tight - particularly in the center where it is under maximum tension. This closure under tension increases the chance of wider, thicker scars which she unfortunately developed. Liposuction was not "missed." Equal amounts were taken from each side. We have limited control over how patients heal after liposuction. Blood supply is a paramount concern with respect to breast augmentation when it is combined with lifts. Too aggressive an approach can lead to horrible complications including loss of nipples, exposure of implants, and multiple secondary operations that are devastating to patients. This patient had large areolae with high nipples. Those with this anatomy can have transposition of areolar pigment and Montgomery glands when the nipple is relocated upward. Contouring of the central lower breast pole can compromise blood supply and result in wound breakdown and implant exposure. There is no simple revision if this occurs. All of these issues that bother her are the result of a prudent, conservative approach predicated by the original anatomy. All issues can addressed with simple revisions in one setting, now that healing has taken place, if she wishes.