I am fairly lean in my upper body. I have mod prof 300cc saline implants overfilled (for rippling purposes) to 360cc..the doctor placed them in a subfascial plane to correct minor pitosis. I wanted a natural appearance but the step off for me looks too round, especially when i wear a push up bra. Is there any way to correct this? I am 6 months post op. The first picture is me laying on my back, they look really round and I dislike it.
What Can I Do to Have a Less Round Appearance?
Doctor Answers 5
Fixing an undesirable round appearance with a change to subfascial silicone implants
I use almost exclusively subfascial placement in my practice. Your breasts have the appearance of sub glandular placement not subfascial. One of the great advantages of subfascial placement in my hands is that the intact fascia really blunts the upper pole step off creating a teardrop effect. I use a subtle variation of the subfascial plane that I call 'cold-subfascial' to ensure that all of the fascia that makes the procedure a success is intact and healthy. My bet is that there is still quite a bit of native fascia in place that has been left on the muscle. I have revised women in your position and always find fascia intact where it counts. There are two other reasons that you have the 'ball effect' that you dislike. Firstly saline implants, which are never used in my practice, are firm and take the ball shape of the round implant, especially when high profile. Secondly the base width of the implants are too small for your chest wall dimensions. You need a much wider, lower profile implant placed in a subfascial plane in my opinion. I hope this helps! All the best, Rian A. Maercks M.D.
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Achieving a less rounded appearance in Breast augmentation
There are multiple factors that lead to an exaggerated, rounded upper pole appearance, not all may apply to your case:
- High profile implants: These types of implants are more projecting, so the transition from the normal chest to the implant tends to be less gradual than moderate or low profile implants.
- Thin chest tissues: If there is not much natural breast tissue, the implant will be seen more easily through the tissues. The more coverage, the more natural it tends to look.
- Sub glandular placement: Placing the implant in the sub glandular plane means that it is over the muscle. The muscle helps to cover the implant, to make it look more natural. As stated in (2), more tissue coverage tends to look more natural.
- Large implant size: As the implant becomes larger, it takes up a larger proportion of the entire breast volume (IE "the natural breast:breast implant ratio" becomes smaller). This results in the breast looking more like the implant (IE rounder)
- Over inflation: Breast implants are somewhat dome shaped. As more fluid is placed into them, they become more spherical and more projected. The manufacturer has guidelines on proper implant inflation, and staying within the guidelines will lessen this problem.
- Insufficient pocket dissection: Saline Breast implants should be placed in a pocket that has adequate dimensions to allow for a gentle tapering of the tissues away from the implant. If not, the implant will be 'stuffed' into a tight pocket, and there will be an abrupt transition from the implant to the unoperated areas, leading to an unnatural appearance. Some approaches are have a higher risk of inadequate pocket dissection (eg. through the belly button)
- Capsular contracture: Capsular contracture is a scar that forms around the implant making it firmer. It also makes the tissues around the implant contract so that the edges of the implant are more easily seen. This is a known complication of breast augmentation, and does have a higher chance of occurring with sub glandular placement.
In your case, the solution depends on how aggressive you want to treat it. First make sure you don't have capsular contracture. If you like your size, then look at changing your pocket to an adequate submuscular placement. If you are OK with downsizing, then also consider a different size implant and possibly lower profile (if your chest muscles are very thin). These are the main factors I would consider in your case, but it your surgeon will have a better chance to evaluate your anatomy. Good luck.
Lawrence Tong MD FACS FRCSC
Improving The Too Round Upper Pople After Breast Augmentation
The combination of subglandular (above the muscle) positioning and overfilled saline implants will give a round upper pole. It can really only be significantly improved by changing to a submuscular position and a lower profile device such as a moderate plus silicone gel implant. In so doing, however, your ptosis may be exaggerated and may require management. This consideration should give one pause to determine which trade-off of the two situations can one live with the best.
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Demarcation upper pole
A demarcation of the upper pole has to do with the pocket location the thinness of the overlying tissues and the amount you are pushing up the breasts. You may want them below the muscle.
Round to Natural
Excessive upper pole roundness is related to several factors. If the implant has very little tissue over its upper edge, this edge becomes more visible. If a saline implant is overfilled, the upper half of the implant will take on a rounder appearance. So the surgeon has to take into consideration numerous factors before performing a surgery. The key to the approach is finding out what the patients goal is.
In your situation, several different approaches could be used. The implant could be place under the pectoralis major muscle in the upper pole. The saline implant could be inflated to its lower limit volume so that it takes on a more teardrop shape. The implants could be exchanged to cohesive silicone gel in a moderate type profile. And finally, additional soft tissue filler (Alloderm, Surgimend) could be used to cover rippling or fill in the upper edge (very expensive). Which approach really depends on your desires, expectations, and what you are looking for.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.