Q: Dr. Eppley,I am looking to get a breast lift revision. I had breast implants and a periareolar breast lift performed over one year ago . Since then I’ve had three nipple revisions due to inconsistent shape and size. I am unsatisfied with the result and I am in need of new approach to hopefully fix what I have left. To deal further, I had the initial procedure done 18 months ago. I’ve had two revisions on my nipples since then. My left nipple continued to be more oval and larger then my right. My right I was very pleased with. The most recent revision was done to correct my left nipple as well as lift the breasts, as my original inframammary fold was showing upon any flexion. Both nipples were revised and I developed on infection on my right side. A tip of nylon suture had migrated to the skin surface and caused the infection. There is also a dark spot on my left nipple were I can only assume is nylon as well. Please see if there can be a revision done to restore my feelings of happiness in having this done. I feel very much like Frankenstein and embarrassed with my bra off. Although if more time is needed to pass and I just need patience for them to heal? I don’t have a good feeling that they will. I’ve attached photos of my recent outcome. Thank you so much.
A: Thank you for sending your pictures and detailing your history. It appears that you have had an original periareolar mastopexy (donut lift) with your implants and have been battling areolar asymmetry and hypertrophic scars since. I am not a fan of the periareolar mastopexy as I have seen too many patients go down the road you are traveling. But despite the revisions maybe it is still worth it to avoid the scars from a vertical breast lift. (although they have a much lower risk of these problems than the periareolar mastopexy) The reason is that all the tension of the lift and the implants is placed on the areolar closure. Inevitably they widen and have hypertrophic problems frequently.
But that is water over the dam so to speak now. The question is whether a third areolar revision (breast lift revision) would be beneficial. Despite having two ‘failures’ at them I would still remain an optimist. But you would ned to wait at least 4 to 6 months if not longer to let the scars mature first. Redoing the areolar scars too soon is just a set up for recurrent hypertrophic scar formation as the scar tissue is still inflamed and highly reactive.
Dr. Barry Eppley
Q: Six months ago I had breast implants with an around the nipple type of lift, I had 350cc silicone implants placed in each breast. Right after the surgery, there were a noticeable difference in the shape of my left breast. It sat lower on my chest and appeared smaller than my right breast. Can this be fixed? I have attached pictures from different angles so you can see the difference.
A: In looking at your pictures, I see a fairly good result. While I do not know what you looked like before surgery, this is an overall nice result, I do see a slight difference in the breasts with the left breast having a small amount of inferior and lateral positioning, This may or may not have to do with the location of the implant.
For the sake of discussion, let us assume that it is an implant location issue. One of the most common reasons for revisional surgery after breast augmentation surgery is implant asymmetry or malposition. This presents in many ways from an implant being too high, too low, too far to the side, to being too far to the middle. Invariably, there is always the good breast and then the bad one. (or as I call it the good sister and the bad sister)
Implants that are too low or too far to the side can be corrected using an internal suture technique decreasing the size of the pocket and moving the implant to a more symmetric position to that of the other side. Expect improvement but not perfection. It is unlikely that your breasts were perfectly symmetric from the beginning and this surgery has likely unmasked that pre-existing issue.
I would also think very carefully about revisional surgery for a minor amount of breast asymmetry. All surgery involves risks which are always greater when a synthetic implant is involved. Those risks are not necessarily less than that of the original breast augmentation/lift surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I had breast implants with a lift over one year ago. While they do look better than before they are very asymmetric. I had 375cc silicone gel implants and vertical breast lifts. The left breast is considerably larger than the right and the implant sits lower and more towards the side of my chest. My plastic surgeon wants to redo the lift on the left and tighten the pocket. Rather than place a bigger implant in my right breast, he wants to take more breast tissue on the left to make them more even. This doesn’t make sense to me and I think it would be better to place a bigger implant on the right to make them look more even. I think he is wrong with his plan but he won’t do it the way I think it should be done. What do you suggest I do?
A: One of the most difficult body contouring procedures to do and get a symmetric outcome is breast reshaping. The combination procedure of lifting sagging breasts and adding volume (an augmentation-mastopexy or breast implants-lift) is challenging and the need for secondary revisions is remarkably high. (25% to 50%) When planning a revision of this operation, there can be multiple options to manipulate including more of a lift or tightening the breast skin, increasing the size of one or both implants, or even removing some breast tissue. Any or all of these may be needed and there are advantages and disadvantages to any of them. While you would prefer to exchange an implant for a bigger size, your plastic surgeon has recommended otherwise. I would make the assumption that he has a lot more experience in doing this surgery and has a good reason for making this recommendation. I would suggest you sit down with your plastic surgeon and discuss your differences. Unless the final result is perfect, and it is likely that it won’t be (better but not perfect), you will never be happy with any outcome unless you understand and agree with the revisional plan.
Dr. Barry Eppley