Unhappy with Final Breast Aug Result - Placement Too Low?

I had a sub-pect. BA 10 weeks ago. I requested a "natural" look, but I also wanted them to sit in a youthful, not low position on my torso. I am 31, 5'5", 120lb, 4 kids. I also body build. I had 200cc round mod Mentor silicones placed, wanting a smallish but shapely result. I'm disappointed--I wanted them to be a bit higher on my chest wall, with a little more upper pole fullness/shape. I think they look too low/sad. I was an empty 34AA before with no real sag. Please help--can they be improved?

Doctor Answers (13)

Breasts too low

+4
Breast implants rest on the breast crease or fold. Breast implants are circular devices ( for the most part). If the circle is too small, it will not reach high enough to give the desired upper pole fullness. You need a bigger base diameter or an anatomical shaped implant to give more upper pole fullness ( you also have some breast differences which need to be addressed with different sized implants and/ or a breast envelope altering procedure.


Houston Plastic Surgeon
5.0 out of 5 stars 10 reviews

Implant settling too much may require revision

+4

Please keep in mind that none of us can give you specific advice without seeing you personally. What I see in the photo looks like the right is shaped differently than the left in addition to being higher. This can be due to a number of things, including asymmetry of your rib cage or a unilateral capsular contracture. The implants need to be positioned within the existing base foundation of the breast. If they are too low then a procedure called a capsulorrhaphy can be done to move them up.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 28 reviews

Implant placement question

+4

Based on the fact that the incision is just slightly up on the breast your implants amy have settled a tiny bit low.  The biggest problem (and not uncommon) is that you really didn't communicate to the doctor what you wanted because 200's are tiny implants and won't give upper pole fullness.  You will probably need a revision with suture repair of the lower pocket and larger fuller implants to get what you want. 

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 51 reviews

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Breast implant revision Wait!

+2

Thank you for the selection of post op photos, I have a feeling that if we had seen your pre op photos that much of this asymmetry would be present before surgery. Massage can lower the implant that is higher, taping the fold can help raise the breast that is lower. A bigger implant will give you more fullness. You have a lot of options, some nonsurgical, some surgical. Stay in close communication with your surgeon, don't panic and feel free to voice your concerns.

Charles Virden, MD
Reno Plastic Surgeon
5.0 out of 5 stars 64 reviews

Low implants

+2

The good news is that your breasts do look very natural and pretty.  I do agree that they are a little low.  I would recommend that you start wearing a tight fitting bra or inferior breast band 24 hrs per day in an attempt to close up the inferior capsule.  You definitely do not want the implants to fall any further.  If this fails, wait at least 6 months postop then consider revision surgery. This should be relatively simple as the capsule will have formed. A larger diameter lower profile implant (moderate profile) placed in your current capsule may be the simplest solution.  Your surgeon may choose to open the upper pole only to allow the extra volume to sit upwards.  Definitely do not open up the lower pole and possibly have your surgeon suture the lower pole of the capsule shut to further lift the implants up.

Cynthia L. Mizgala, MD
Metairie Plastic Surgeon
5.0 out of 5 stars 19 reviews

Implant Postion after Breast Enlargement - Too Low?

+2

Hi Lillabel,

There are many factors that go into the final appearance of breast implants and while it's tempting to assume that all factors are under the surgeon's control at all times, that's not necessarily the case (or, more accurately, really not the case at all).  Your final result depends on what you look like before, the surgery that is done, and the way that your body heals after that surgery.

So whereas 200 cc implants might give the look you want in someone who is younger (sorry!), who has not had kids, and/or who had smaller, higher, tighter (sorry again) breasts to start with, that might not be as possible for you.  In saying that you were an "empty 34AA" before, what you're suggesting is that you had a certain amount of loose skin which is, of course, to be expected.

Breast implants alone do not provide a lift specifically, even if they (obviously) improve the overall appearance of the chest.  They can provide some superior fullness IF they are large enough for the pocket, or else you have to do something to make the pocket smaller, elevate the nipple, etc. - all of which are additional procedures that fall into the "lift" category.  You may or may not want them but you at least have to consider them.

If you do not want any of them, then you would most likely need larger implants to obtain more superior fullness.  Even then the lower portion of the implant will be at the bottom of the pocket; ie., where yours are now, but at least the upper portion will extend a little farther "north."  They will be a little heavier, they may sag a little more over time (nothing's perfect)  but I think they would be more likely to give you the overall result you're looking for.

That being said, there's only so much that can be determined via this forum; the rest are just ideas that you have to discuss with your plastic surgeon.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 155 reviews

Breast implant revision

+1

Thank you for the question and  good quality pictures.

I agree with your assessment that the implants may be slightly low in relation to the nipple- areola complexes. Revisionary surgery will likely involve lower pole capsulorraphy ( use of  internal sutures  to repair the inframammary fold areas.

If revisionary surgery is decided upon, it will be 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 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 press 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.
By the way, the most common regret after this operation, is “I wish I was bigger”.


I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 781 reviews

Implant position

+1

ideally should be symmetical and level on the chest.  Still, asymmetries can and will occur.  I hope you can discuss your concerns with your surgeon who did this for you.  Waiting to allow for complete settling of your implants is strongly suggested before considering any further interventions.  Hopefully the time and settling will resolve your concerns.  Your size you picked is not very large by my patient's standards and I hope you were able to visualize your results when you sized pre-operatively so you could see what you were getting. 

Your best option is to thorougly discuss this with your doctor as options will always be available for you to consider.  Unfortunately, most of these options will involve some additional costs to you.  You should also look closely at your pre-operative photos to see if your nipples were perfectly level or slightly tilted as it can sometimes influence where your implants sit, again depending on what you decided to do with your surgeon.

Best to you in achieving your goals.

Curtis Wong, MD
Redding Plastic Surgeon
4.5 out of 5 stars 17 reviews

Implants and natural?

+1

Higher implants would not be as natural.  If that is what you want, you probably need a wider base implant and one with some more projection. An exam would allow me to be more precise.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast Aug Result - Placement Too Low?

+1

Regarding: "Unhappy with Final Breast Aug Result - Placement Too Low?
I had a sub-pect. BA 10 weeks ago. I requested a "natural" look, but I also wanted them to sit in a youthful, not low position on my torso. I am 31, 5'5", 120lb, 4 kids. I also body build. I had 200cc round mod Mentor silicones placed, wanting a smallish but shapely result. I'm disappointed--I wanted them to be a bit higher on my chest wall, with a little more upper pole fullness/shape. I think they look too low/sad. I was an empty 34AA before with no real sag. Please help--can they be improved
?"

One of the complications associated with the breast fold incision is an under dissection below the fold. One of the major weaknesses of the breast fold incision is that only the breast side of the incision may be lifted. This is not always possible when implants are placed and as result of lifting the lower edge of the incision off the chest wall, the scar is freed to move up on the breast as the implants tend to go lower than intended. As the implants sag, the breast loses its upper pole fullness.

You can try and limit this process with well fitted bras but if it does not work you will require a revision operation on the fold.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 63 reviews

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.