I had a BA & TT done 5 months ago. Overall he did beautifully, however, the upper region of my breast is still not full. When I asked about a revision he said he didn't believe I could handle bigger. BW is 12in. was an A; now a B. I250 mod prof plus on left & 300 high profile on right (to correct asymetery: prolapsed rib cage). Would the Natrell be a better option to suit my narrow width &allow more upper fullness? Is textured really better for my case? Is his concern for sag in 1-2 years legit?
Is This Overly Cautious: Breast Augmentation? (photo)
Doctor Answers (10)
Larger breast implants for upper pole fullness
I agree that overall its a good result. If you want more fullness in the upper pole, I think you can definitely place a larger implant. If you are going to go larger, I would suggest at least 100cc per side to make it worthwhile. Without measuring you myself, I cant really give an opinion on HP or moderate plus. I would suggest a larger implant rather than fat grafting.
Chest Wall Asymmetry and Breast Implants
I think the answer here pertains not to breast implant size or shape, but as to your chest wall. The implants in your immediate post op photo are close together; the longer term photograph demonstrates them to be even closer. In patients with a pectus deformity (depressed breastbone) there is a tendency for the implants to move towards the center. Fat grafting in the upper pole can work well as the fat will stay where it is placed, whereas implants can move overtime. I think your size determining feature may be rib position more than breast width or size asymmetry. I would wait to make certain that your implant position is stable before embarking on any revisionary surgery.
Upper pole can be improved with fat
If your desire is to have more fullness just in the upper pole then you may be a candidate for fat grafting. I don't like the HP implants in standard augmentation because of their round shape and tendency to cause impression into the chest wall. Another option would be to consider a shaped textured Sientra implant. I would be careful about doing too much though. It appears on your pictures that you have a great result. Best of Luck!
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Is This Overly Cautious: Breast Augmentation?
Very hard to evaluate via posited photos. But might guess is a right donut lift, exchange to UHP silicones of different sizes, plus fat grafts for fine tuning.
High profile breast implants to increase size
While not suitable for everyone, in general the use of a high-profile breast implant that matches the breast base diameter is the largest size that should be used. It isn't as natural of a look however. Textured implants will probably not make a difference.
Consider higher profile implants
Thank you for the question and the photos. You may want to discuss higher profile implants. You can maintain your current breast implant width and just increase the projection of the implant. Instead of moderate profile plus and high profile you can consider high profile and extra high prolfile (Allergan 20 and 45 style implants respectively). In addition, I think your breasts have a little more room laterally (on the side) to allow for fullness, thefore a slightly wider implant can take more space laterally without any additinoal space taken up medially (toward the cleavage). Fat grafting to the upper pole is also an option. Textured versus smooth is not that really a key issue for you.
All the best,
Dr Remus Repta
Web reference: http://drrepta.com
Improvement seems possible
It seems unfair for us to comment on your surgeon's work, as we cannot see you in person. However, I think you can likely get an improved result. It is difficult in your photos to see the rib cage issues, and sometimes a person has to choose between shape and size or symmetry. In other words, we can often achieve a similar volume on both sides which will give you an even look with your clothes, but will not necessarily give you a mirror image on each side when you are not clothed. This may be true if you have a significant asymmetry between the 2 sides.
I don't think textured is really better, and I think you may be able to increase your size, but a full in person consult is best with a board certified plastic surgeon, preferably a member of the American Society of Aesthetic Plastic Surgery.
More Upper Fullness after Breast Augmentation
Based on your pictures, I would not suggest larger implants as I don't think there is room on your chest for wider implants. Ask your surgeon if fat grafts to the upper breast would be appropriate to give you more fullness.
Overly Conservative Breast Augmentation
For a woman with a 12 cm chest wall width a patient can get more than 300 cc. However, it is important to remember that different people have different views on aesthetics. In my practice, if the implant can fit the chest wall dimensions I will perform the breast augmentation for the patient. For instance, there are patients in whom I will place 700 or 800 cc implants in a primary augmentation. However, other plastic surgeons may place implants up to only 450 to 500 cc.
Based upon the 12 cm (I imagine, not inches), but not based on examination, you could certainly tolerate HP implants as large as 425 cc using Natrelle implants. I am not a big fan of textured implants, and rarely use them, and I am not sure why your surgeon preferred them in you.
No comment on the difference of 100 cc on sag. I don't think you can know for sure.
All the best.
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