Greetings. It has been 3 months since my breast augmentation. My implants are touching each other ( no gap between them). I'm 5'4, and 130 lbs. Also, when I move my pectoral muscles even in the slightest my whole breast jumps. I will change my implants to smaller ones ( 350cc). -Will I need a lift if I go down to 350cc ? -Will switching to smaller implants prevent me from getting symmastia again? -What about muscle distortion? I'm attaching a picture, how would you correct my problem?
Will I Need a Lift If I Reduce my 450cc Implants to 350cc? (photo)
Doctor Answers (15)
Problems created by oversized implants
There are several problems here and I would agree with Dr. DeMars regarding addressing them. Your problem was created by thinking in terms of volume (cc's) alone and not dealing with dimensions. Your current implants are too big (specifically too wide) to fit properly behind your breast and they displaced to the upside and to the medial side. Unfortunately this cannot be solved by just putting in a smaller implant. The width and height of the implant has to be reduced (not necessarily the forward volume) and because the capsule/pocket space is too big to the medial side, this will have to be reduced by fairly complex capsule maneuvers (neopocket) or a dermal matrix graft to the medial side. Releasing the pectoralis muscle edge in a dual plane is also needed so the lower pole can fill out and reduce the pec pull distortion. This should be done through an inframammary crease incision whether the original was done that way or not (another reason to use an inframammary crease incision for primary augmentation).
Implants do not lift breasts and larger implants do not lift them further. Removing or reducing implants does not make them sag. A properly sized and positioned implant could have been positioned behind your breast and a lift was not needed then or now.
Breast Lift with Implant Downsizing
From your photographs, it appears that you have several issues relating to your breasts. There is the issue of synmastia where the breasts are touching in the midline - this may be related to your anatomy or if there was over-dissection of the pocket when the implants were placed. Also, your nipples are in a lower than ideal position at the present time, and it is likely that you will be more in need of a lift after downsizing of the implants. In addition, it is possible that you will need a revision of the pocket to recreate a more normal space between your breasts. With respect to the animation or contraction of the breasts, the only solution is to move the implants above the muscle, but this can create other issues with implant visibility. See a board certified doctor in your area.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon
Synmastia correction by site change
The best way to correct synmastia usually is to change the pocket. By creating a fresh pocket, the plastic surgeon can control the space. It is usually easier to do this rather than try to "fix" the existing pocket. In my revisional work I also sometimes use Strattice to reinforce the pocket. It his hard to tell just from the photos, but it appears the right implant could be crossing the midline-which would be synmastia. Judging from your pictures, I do not think you will a lift, even if you reduce the size of your implants. Since you are only 3 months after surgery, I hope you are having a very thorough discussion with your plastic surgeon about your options. If you are reducing the implant size because you think you are too large, I find most patients need to reduce the volume by at least 100cc and also it is very soon after surgery to make this judgement. However, if you do have synmastia, downsizing the implant and narrowing the width could be very beneficial. As mentioned by the other doctors, the width of the implant is a crucial variable. A thorough discussion with your board certified plastic surgeon will help clarify your options. Hope this helps.
Tracy M. Pfeifer, MD, MS
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Difficult to say without exam
Without an examination, it would be difficult or irresponsible to say what I think would be in your best interests, and it would be unwise for you to place value in the advice given by a surgeon who hasn't examined you.
Return to your surgeon- who HAS examined you and knows your situation. If for whatever reason, you have doubts about what they are recommending, visit another surgeon Certified by The American Board of Plastic surgery for an opinion.
Remember to always weigh these opinions based on your knowledge of their sources- the quality of each surgeon's education, training, experience, and outcomes. In other words, an opinion from a surgeon with a great education, excellent training, and amazing outcomes would mean more to me that one form someone who did not have these....
Based on the photo it is difficult to tell if you have synmastia or if the implants are just close. I would be surprised if the two capsules actually are together. You may not need a mastopexy after changing to implants 100cc smaller than your current ones. Also the muscle probable has not been fully released inferiorly. The muscle should be fully released inferiorly, you should have a capsulectomy and some medial suturing of the tissue so that the implants do not move medially and the implant size reduced . Then if the breast still have to much ptosis a mastopexy could be done.
Lift is usually required if replacing current implants with smaller ones
It appears that you may be in need of a lift already or it may be that the angle of the photo is misleading. At any rate, your PS should be able to determine after replacing your implants if you would benefit from a lift. A circumareolar lift would be best in your case (this can be done on the same day). In order to improve your cleavage a medial capsular repair is warrented. But, in order for the repair to be successful at least 6 months is needed for capsule to develop and become strong. Best wishes, Dr. H
Change of implant
A different way to look at your situation to analyze your anatomy and determine what implant would be appropriate to reduce the size and give you the shape and form you desire without requiring a lift. Since your nipple appear to be on the underside of the implant below it;s equator, I suspect that a smaller implant with a narrower diameter would place the nipple in a more appropriate position.
While you do not appear to have true synmastia, you certainly are at risk for developing this over the years. The size of the implant is only part of the solution. The location of the medial aspect of the capsule is also significant is the development of synmastia.
Robin T.W. Yuan, M.D.
Without an exam it is difficult to say but you may need a small lift of the areola to compensate for the reduced size. ...or not.
Breast augment revision, smaller implants and lift
Your problem is a little more complicated than just smaller implants. Your muscle has not been adequately released at the bottom of the breast and definitely needs to be made into a dual plane implant pocket. That will stop the implants from too musch movement with muscle activity. Then you need to have some internal suturing to close off the space close to the breastbone on each side to get a little separation. This part is difficult. Make sure you see someone who has experience in that. And finally do not get a lift at this time. If the implants are properly sized and centered behind the nipples it is unlikely a lift is needed. Your implants are so oversized for your dimensions they are making the nipples look lower and just that correction should get the nipples pointing forward and you can avoid extra scarring. BTW, this surgery cannot be done through the armpit. I would suggest you see several surgeons to make sure they have experience in these corrections.
Correction of Symmastia and Large Breast Implants
There are a few things to consider in a case where large breast implants cause symmastia
1. Using smaller implants seems like a good idea for someone with your body proportions and problem. The touching together of your breasts (symmastia) can be corrected by:
- Suturing the breast capsule (which after 3 months after surgery may not be fully developed so more time may be required), or
- Using a piece of biological tissue or mesh, or
- Creating a new implant pocket
- Downsizing the implants will make the symmastia correction more likely to last using the above techniques
2. Severe breast movements with muscle contraction can be corrected by placing the implants in a pocket above the chest muscle.
3. The question of needing a lift is harder to answer. If I had a patient in this situation, I would offer to downsize the implants and correct the symmastia. I would then offer my patient either waiting to see if a breast lift is needed, and getting permission to do a breast lift at the same time if I feel it is necessary. However, this is based on a patients skin laxity, breast tissue and surgical judgement.
There may not be one best answer to help you improve things so be sure to have a good discussion with your surgeon and prioritize what you want most.