I am 5'1 130lbs. 34 DDD. saline breast aug in 5/12 640ccs on the right breast. 610ccs on the left. Both implants bottomed out... bad. Nipples looking up bad. I had a bilateral capsulorrhaphy with the same surgeon in February 2013. Only 3 days after the surgery I noticed the right (640cc) implant moving. My right breast is now lower than the left. I am considering smaller implants and an internal bra. I'm concerned about loose skin but I'm trying to avoid the scars of a breast lift. Suggestions?
Getting Smaller Implants. How Much Can I Shrink from 640/610 Ccs Without Getting a Lift? (photo)
Doctor Answers (18)
Getting Smaller Implants. How Much Can I Shrink from 640/610 Ccs Without Getting a Lift?
Based on your photos, you definitely need to switch to smaller implants and and repair the inframammary folds. Once the implants are in the correct position, your nipples should be more centered over the implants. Hard to tell if a mastopexy is needed without an exam to feel the tissues. Also need to determine how much smaller implants you want to go with.
Fixing "Bottoming Out" From Breast Implants
Thank you for your question and your photographs. Your petite frame cannot handle the large implants and you have had two procedures that demonstrate that. Your rib cage and soft tissues can accomodate only a MUCH smaller size. There are several approaches. Some plastic surgeons would tell you to remove the 640 and 610 implants and let your tissues heal before proceding. You can then tell how well your skin will respond and make decisions from there. I would guess that an implant half your current size is needed and you may need an ADM (internal bra) to secure the fold at the bottom. A one step method is possible, but less likely t o be successful. You do not need any more disappointments. Good luck!
The capsulorraphy was the right operation, but unfortunately, it is difficult to get it to work with large implants. A vertical lift with smaller implants is probably your best option at this point. Just make sure you find someone who is experienced in the procedure. It is not as simple as it sounds.
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Recurrent bottoming out problem with breast implants
It makes perfect sense to consider smaller implants if you are having problems with bottoming out. I am not sure about what is meant by an internal bra procedure without a mastopexy or breast lift procedure. More than likely you would need an inferior capsulopexy or possible support of the implant with Stratice.
Often with bottomng out it is best to use a smaller implant and repair the fold. As for loose skin, I can not say because I have not seen you to make an assessment.
Getting Smaller Implants.
To answer a question specifically about your condition we would need ht., wt., and front and side photos at the very least. If the lower skin, on exam, is excessively thin, Alloderm is a posssible answer. I rarely find the need for it when doing a capsule tightening to recreate a damaged fold. Burning the capsule with a cautery and oversewing it with an appropriate suture coupled with reducing the implant weight works over 90% of the time. It requires wearing a bra 24/7 for 8-10 weeks and avoiding any type of upper body exercise or heavy muscular activity during that time. I think you will need to reduce the implants by at least 200cc.
Getting Smaller Implants. How Much Can I Shrink from 640/610 cc Without Getting a Lift?
Smaller implants with a dermal matrix sling may be the best option to avoid further tissue thinning and bottoming out. It is difficult to estimate the volume that could be reduced before a lift or a skin tightening procedure would be necessary. Once you decide how much smaller you would like to go, an exam or pictures would be necessary to give valuable insight into the question of whether a lift will be necessary. Kenneth Hughes, MD Los Angeles, CA
Best Breast Revisionary Operation for Me?
I am sorry to hear about the complications you have experienced. Based on the limited photograph, I do not think that breast lifting will be necessary. Capsulorraphy plus/minus the use of acellular dermal matrix will likely be helpful in achieving the results you are looking for.
How much smaller the breast implants you will be able to use will depend on your physical examination characteristics, such as skin elasticity qualities.
I would suggest that you select your plastic surgeon carefully based on demonstrable ability/success with revisionary breast surgery. Then, communicate your goals carefully in regards to the breast size that you are hoping to achieve. In my practice, I find the use of goal pictures (not terms such as “natural” or "C or D cup") helpful during this communication process.
After this communication process, with the help of intraoperative temporary sizers and careful measurements (dimensional planning), the best breast implant size/profile to achieve patient's goals can be selected.
You may find the attached link helpful to you as you learn more about revisionary breast surgery.
You MUST have a lift to reshape and reposition your breasts
Your before photographs show you had asymmetry and ptotic breasts. You would have benefited from a lift and implant initially. You now have too large of implants that need to be removed, stretched skin envelope and distorted breast tissue. You are an excellent candidate for a new technique called Implant Exchange with Mini Ultimate Breast Lift. Using only a circumareola incision it is possible to remove the implants, place new implants retro-pectoral of appropriate size, reshape your breast tissue creating upper pole fullness, elevate your breasts higher on the chest wall and more medial to increase cleavage. Aligning the areola, breast tissue and implant over the bony prominence of the chest wall will give maximum anterior projection with a minimal size implant. This technique avoids the ugly vertical scars of the lollipop or boat anchor shaped incisions.
Gary Horndeski, M.D.