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Want to Downsize Implants - 375cc Mod Plus Implants

I had breast augmentation 6 months ago and felt my breasts were too big then and the feeling still lingers. I had 375cc Moderate Plus silicone implants put in on a 5'9, 120lb frame. I feel my current boobs sag too much, have that "matronly" look and make me look fat. I would like to downsize and want my breasts implants to be higher with more upper pole fullness and more "fake" and "tight looking." How can I achieve this? (Before and after photos included)

Doctor Answers 12

You cannot have both a smaller breast with increased upper pole fullness!

When you say you have a matronly look to your breasts I believe you are referring mainly to your right breast that has bottomed out resulting in a lower fold on the right versus left. Bottoming out creates a pseudo droopy look and is also the reason your right nipple complex is higher then your left. Your left breast appears fine to me. To achieve the look you desire it is first necessary for your surgeon to correct the bottoming out of the right side. This means that the fold under the right breast has to be raised to the level of the left and this will then also correct the nipple asymmetry and eliminate the droopy matronly appearance.  However to have the "fake" upper pole fullness a larger implant will be required and downsizing is out. And yes, larger breasts do tend to make one look heavier. You cannot therefore have both a smaller breast with added upper pole fullness and will have to decide between one goal or the other.

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Breast implant revision/sizing

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.

I hope this helps.

Bottoming out

From the photos, it looks like you are buttoming out (the distance from the nipple to your crease is too long). This deformity will require excision of the redundant tissue when replacing your implants as well as tightening down of your capsule in this region. If your capsule is not strong enough, you may need an allograft to support your inferior breast pole. This will give you more upper pole fullness.

Downsizing breast implants

Given you age and excellent skin quality, i think you could easily downsize ot a 250 and achieve a nice result.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 54 reviews

Down Sizing Implants and Expectations?

You have several different issues.

1) Your right implant has bottomed out. Your fold on the right is lower than on the left. this makes your right nipple appear even higher than your left (you had some nipple asymmetry preop).  Also, with a bottomed out implant, you have less upper pole fullness.

2) Your implants appear too wide for your frame. In your preop picture, your breast width appears narrower than the implant width which gives you more of the lateral boob look that a lot of patients don't like. This also lends itself to the feeling that they make you look fat.

What I recommend is to remove these implants, tighten the pocket on the bottom right side, use a smaller high profile implant that is suited to your preoperative breast width or base diameter. I also would have you wear a specific supportive bra after surgery to help enforce the pocket repair on the right side. 

What I wouldn't recommend is to go larger with the implant because it will cause more issues with bottoming out. I also would not recommend going above the muscle (if you are currently under the muscle). It may give you more upper pole fullness, but it can lead to long term problems such as rippling even if it is a silicone implant.

The bottom line is that there will be some compromise here. If you sincerely want to go smaller, then you have to sacrifice some of the upper pole fullness you desire.

Hope that helps and good luck!

Dr. Babak Dadvand 

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 14 reviews

Breast augmentation

If you are unhappy with the overall size, and since you area already at six months post-op, it is perfectly reasonable to seek consutlation regarding your concerns. Good luck.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Breast augmentation

The left bret is in good position, the right has bottomed out. The problem is that your frame may not allow whT you really want. If you look at your pre-op photo, you will see that your breasts are low to begin with. To achieve upper pole fullness larger implants are needed, even then it will not necessarily give exactly what you seek b/c of the position of your breasts relative to your chest.

Shahin Javaheri, MD
San Francisco Plastic Surgeon
3.5 out of 5 stars 2 reviews

Revision breast augmentation: Change implant size or change the shape of the breast.

Revision breast augmentation is commonly done for implant size change. Looking at your pre-op and post-op photos it looks like your implant has accentuated an already long nipple to breast fold distance, which can happen secondary to the weight of the breast implant or an already long distance. It appears that your breast fold is fairly low and could be raised with internal sutures, combined with a smaller implant and possibly an internal mastopexy with an acellular dermal matrix sling. These can all have the effect of increasing lower implant support and a lifted look. Implant plane change to below or above the muscle may help as well.

I hope this helps.

Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
5.0 out of 5 stars 17 reviews

Revision breast augmentation, breast augmentation, breast implants, Dr. Whitfield, plastic surgery

It appears that the right breast fold is lower.  The postion of your implants is a little lower as well.  Is the device above or below the muscle?  Changing the size and the pocket location are techniques that can be used to help improve your result.  Most importantly it is necessary that your surgeon understand what you want.

"You can't always get what you want..."

You have bottomed out and your implants are too low.  Are they submuscular or subglandular?  The problem is that you can't go smaller AND get more upper pole fullness.  A HP implant with add to the upper pole but to go smaller will necessitate a narrower implant which will give you a big gap in the middle, like tennis balls with a mile in the middle.  You do need a submuscular revision, or repair of the pocket if you are submuscular, but to get the upper pole you want, you will be even BIGGER than you are now.

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.