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Questions about downsizing, profiles, and lifts (picture included)

asked 9 months ago by hindsight
Latest answer by Tom J. Pousti, MD
Question viewed 596 times
Tags: breast feeding, downsize, lift, rippling

I am 5'2, 108 pounds, and have a 27" ribcage. I had my first breast surgery about 2 and a half months ago. I am looking to downsize but am unsure on whether to change profiles. Currently, I have 425cc Natrelle style 20 silicone HPs under the muscle. I was a deflated and very saggy C-cup before surgery and wanted to end up in the full C to small D range. I was recommended "no less than 400cc" by my doctor. I am now sizing out much larger and want a revision (250 - 325cc). I also had a full anchor lift. I feel as though I have the terrible scars without the actual benefit of lifted perky breasts. It was explained to me that a high profile implant would mean more upper fullness, which I lost after breastfeeding my children. Instead, the high profiles look like they hang low without providing fullness to upper chest. Also, my asymmery is still present. My right breast is noticeably larger and the areolas are large and more uneven than before. All these issues were discussed with my doctor before surgery but were not adequately addressed. I am very unhappy and disappointed with my result, and I'm left needing the same things I did before surgery (lift, smaller areolas, improved symmetry). Which implant size and profile would better suit my petite frame? Can the implants be positioned higher, or is it a matter of changing to smaller implants that'll help with the positioning? Due to the submuscular placement, would I need pocket/muscle revision for smaller implants? Would I need a minor or full lift? How long do I need to wait before I can have my areolas reduced without serious risks? Another problem is that I have very visible rippling. Would a lower profile mean even more rippling? My doctor is now recommending Natrelle style 45 because it's the highest profile, which is supposed to cause less rippling, but I fear it will make matters worse.

8 answers to Questions about downsizing, profiles, and lifts (picture included)

Breast implants and revisionary surgery

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" 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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Disappointing breast lift and implant

I agree that your current result looks poor to me. There are many factors that contribute to such a result including but not limited to the patient's own tissues and elasticity, the skill of the surgeon, the choice of procedure and implant, and the healing of mother nature and scar tissues. You will not get better with time in the current result unfortunately in my opinion. You will likely do better with a smaller implant, not a bigger one, placed under the muscle and... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Breast Implant Revision

Based on your pictures, it appears that you would greatly benefit from a submuscular (under the muscle) silicone implant with a mastopexy at the same time. This should give you a much more natural result. With such large implants like you have now and poor skin quality, it is difficult to achieve a natural result without downsizing the implants and redoing the lift. Good Luck.

David Shafer, MD
New York Plastic Surgeon

Breast issues

Thanks for the photos! Certainly going smaller can be achieved, and with this, the areola can be made smaller and the envelope tightened a bit. As for the right impalnt for you, it depends upon your exam and goals.

Steven Wallach, MD
Manhattan Plastic Surgeon

Too large implants, small chest and ptosis

You have a combination of complex problems now. The implants are too large for your chest. Even though you had a lift, the breast tissue stretched out and it appears that the quality of the skin is poor. Smaller implants would solve the size problem. You will still have to deal with skin quality and ptosis. My recommendation is have the implants exchanged to a 300 to 330 cc moderate profile silicone implants, wait a few months to allow the pocket and the stretched out skin to settle and get... more

Raj Chowdary, MD
Allentown Plastic Surgeon

Breast lift procedures improve breast shape

I would consider using a small implant and revising your anchor-pattern breast lift around this smaller volume. Wait several months before attempting this revision. You may need some breast tissue removed to accomplish this revision.

Scott Sattler, MD
Bellevue Plastic Surgeon

A full lift and smaller implants

Sorry for your unhappy result. It appears as if your implants are too large for your small frame. I think that you need to have your mastopexy redone, possibly tighten your capsule on the inside ( capsuloraphy), both to make a snugger pocket for a smaller implant. It is hard to tell in pictures, but somewhere in the 275 to 300 range with a moderate to moderate + implant would look good. Sometimes, however when people have poor elasticity in their skin lift procedures will... more

Scott Tucker, MD
Winston Salem Plastic Surgeon

Revision Augmentation-Mastopexy

Your issue, like many other patients, is complex and can be answered through a number of different techniques by different plastic surgeons. Importantly, in my opinion, the Style 45 is not an option. I've now personally removed these implants from three patients in which they already demonstrated (through several months) an irreversible depression in their rib cages. While high profile implants can help with rippling, if you have a large base width and stretched out tissue from previous... more

Jeffrey D. Hoefflin, MD
Los Angeles Plastic Surgeon

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