Opinions on Downsizing My Implants. Having Trouble With Bottoming Out, And Other Issues

I'm currently 350&375 cc Saline w/a Benelli. 34D/DD. 5'6, 126lbs. Complications I'm having are Bottoming out,Double bubble, Excess skin ,Too large ,Stretched nipples/loss of total sensation... I consulted a reputable surgeon in regards to Revision with a lollipop lift &internal bra. I feel top heavy & want to downsize to a C cup, but he highly suggested against me going more then 50-75cc smaller. He said "it would look odd/there will be more skin to deal with."Should I refrain from downsizing?

Doctor Answers (10)

Stretched out skin and breast revisions

+3

Dear LuluMylu,  First, thank you for your question.  I agree that without being able to perform an examination and a formal consultation, it is hard to give you an exact answer to address your concerns.  I would like to separate your question into smaller parts.  First, there is the issue of size or rather too much of it.  I believe you can and should downsize given the problems you are having and I do not believe that a drop of 50-75cc will make enough of a difference.  From your photos and the examples you also sent, I suggest a drop into the low to mid-200cc range to better match your desired size.  Second, the "bottoming out" issue which I do not think can be addressed by an internal bra lift alone.  This is a problem of stretched and damaged tissues and just tightening these tissues does nothing to address the underlying problem, that the tissues are damaged and stretched and are not longer capable of supporting the weight and stress of the implant.  Borrowing from our breast reconstruction experience, I would suggest using an alloplastic filler such as Strattice or others to reinforce and support the bottom of your breasts.  This will also allow you to shape the pocket to match your desired implant size.  Lastly, you now have too much skin and enlarged, stretched N-A complexes.  The correction for this would be a mastopexy but which type would be determined by what size implant you are going to use and also your skin characteristics-something that can only be determined by an examination.  Your's is a difficult problem and I suggest getting a few consultations with board-certified plastic surgeons before proceeding.  Good Luck.


Saint Louis Plastic Surgeon
4.0 out of 5 stars 18 reviews

Revision of Breast Implants with Lift for Improvement

+3

Hi there-

Please understand that without a formal examination, you should take anything you read here with a grain of salt, but my opinion based on what I hear and see is that your would actually be best off reducing the volume of your implants and undergoing a well-done breast lift with revision of your pockets.

Good luck!

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 105 reviews

Downsizing implants

+2

In considering revisions it is critical to establish what caused what, what the problem is, what will be done, and what effect/result that would have. In my opinion based on the photographs, the main problem is a double-bubble on the left. There is no "bottoming"  out that I can see. The problems with the nipple-areolas was caused by the periareolar lift which does little to actually lift the breast, and the "excess skin" was there before the procedure and not caused by the implants. It doesn't even look as if there is enough ptosis (sag) to justify a lift procedure. 

My recommendation would be a replacement of the implants with those of the same width but a lower profile and to internally correct the double-bubble with the release of the pectoralis, fascia, or breast tissue attachment through an inframammary crease incision. Since there are already scars around the areolas, a true lift could be done by adding the vertical incision but that would add additional factors and possible problems and the only benefit would be to raise the breasts a bit higher on the chest. The simplest is to lower the profile of the implants and fix the double-bubble contraction on the left, perhaps a bit on the right too. 

Scott L. Replogle, MD
Denver Plastic Surgeon
4.0 out of 5 stars 1 review

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Breast revision with subfascial placement

+2

In Miami we commonly see this sort of problem as it is very common for surgeons to place large implants.  It is my preference to revise such problems with a swith to a low profile implant in a carefully designed subfascial plane.  In this way I can place the breast in a more attractive higher position and adjust the nipple with either a lollipop scar or one of my proprietary 'no-scar' techniques which hide scars at the nipple-aereolar junction.  once the tissues are distorted and stretched it is very difficult to get a lasting result even with the advertised internal support products.  I consistently achieve supportive and natural appearing correction with downsizing by using the strong connective tissue that is a part of your chest wall musculature.  I dont know of any other long term effective way to deliver a beautiful result.  I hope this helps! 

 

All the best,

 

Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 32 reviews

Implant & Lift complications, consider....

+2

You are correct in your assessment from what I can tell.

Benelli pexy tends not to do a significant lift, and the areolas tend to spread.  Sensation loss may happen even without a lift.

I am not sure but if your implants are over put them under.  I think that they are under however, and I find that the double bubble can usually but not always be fixed with a full pexy, and scoring from the undersurface. 

I am not sure if you have bottoming out, or you just have malpositioned implants.  In either event, my first attempt would be a pocket revision, with the intent to raise and centralize the implants while improving shape and symmetry.

A smaller implant may not solve problems.  However Consider this...ask your plastic surgeon to show you some low profile implants.  This can actually reduce the volume of the implant while allowing you to get a natural appearing breast.  You won't have the same projection, but it may be just the look you are looking for.  Try silicone.

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 49 reviews

Opinions on downsizing

+2

50-75cc won't make much difference in my opinion. Your breasts must have been a full B to begin with. If you are willing to add the scars to get a better breast than go for a full lift and downsize to about 200cc or so, especially if those pictures are what you are after. Sounds like you'll be happier with a signifiacntly smaller, tighter, sexier breast.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 28 reviews

Downsizing breast implants

+2

Dear Lulu.  Several weeks ago I performed a similar operation on a woman with 750cc submuscular implants.  Needless to say she looked strange and her children were embarassed to be seen at the pool etc. with her.  I was able to downsize her to a 475 and close off the lateral and lower pocket.  Her skin tone was good and we did not do a mastopexy.  I did repair the crease to raise it.  I also used Strattice to support the lower pole.  

On cases similar to yours I do not immediately do a lift as it may not be needed.  A lift can be done as a secondary procedure even under lower (although it is more comfortable to do with sedation)  as we are just adjusting the skin or nipple position.  I would discuss this with your doctor and see now reason why you couldn't go smaller than 50-75cc.  Since you already had the "benelli lift" you could try redoing that without the lollipop, as you could always add the vertical scar.

You might want to get opinions from several doctors before making a final decision.  Good luck, Dr. Schuster from Boca Raton

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

Answer to RealSelf.com question about breast problems: sagging & double bubble

+2

I would generally agree with the plans of your plastic surgeon, however based on the photographs that you have included, I would decrease the size of the new implants more substantially.  Based on your current size a decrease of 75-100 cc would seem to be appropriate.  The use of intraoperative implant sizers should be helpful in deciding on a final size.  I agree with the plans for a lift (and perhaps internal support) with implant size reduction.  Best of luck.

Eric T. Emerson, MD, FACS
Charlotte Plastic Surgeon
4.5 out of 5 stars 16 reviews

Breast augmentation revision?

+2

Thank you for the question in pictures.

I think your plastic surgeon has a good plan for you. Unfortunately, given the different variables involved  with your surgery including the adjustment of the breast implant pockets with capsulorraphy ( “internal bra")  and the adjustment of the skin envelope ( “lollipop lift”)  it is not possible to know what size implant will be necessary. It may be in your best interest to allow that decision to be made intraoperatively with the use of temporary sizers, with you  in the upright position. This will allow for more precise implant size selection than trying to predetermine the size of implant that will best fit after all the adjustments are made.

I hope this helps.

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Complex Breast Revision: Reducing Complex Problems into Several Simple Ones

+1

Patients who have had breast implant/breast lift issues are best approached by evaluating their goals and each problem which they note.  In the case of a patient wishing to downsize, there is no reason why a significant downsize cannot be performed.  If a doctor is discouraging you, it is likely because they feel uncomfortable at a major revision of the breast pocket which would be required with a significant downsize. 

A pocket revision would require a capsulorrhapy, a procedure in which the pocket is reshaped smaller with sutures.  This also can help correct the double-bubble.  Areolar size can be reduced by converting your circle (Binelli) lift to a vertical or vertical with small breast crease skin reduction.  However, the smaller you go, the more likely a small full mastopexy incision pattern will be required.  This may help you decide how much implant volume reduction makes sense for you.  I hope this information helps!  

Best wishes,  Dr. Bresnick

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 17 reviews

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.