David L. Mobley, MD, FACS

You appear to have Grade II ptosis which is our fancy way of saying borderline drooping.  With moderately large implants and a dual-plane technique you should get a good result using high profile silicone or extra-high profile silicone gel implants.  The incisions could either be inframammary or periareolar.  That's the good news, and for someone who wants to avoid a lift and "doesn't mind" placement being a little low, it usually works out fine.  

Contrary to what many of the other doctors have said, I do not think you will be able to completely correct your flat upper pole, since the implants will sit relatively low.  This is not necessarily bad if you are aware and okay with that appearance.  On the other hand if you truly want excellent correction of the upper pole and implants that don't sit relatively low, I would consider a breast lift.  You should make certain to observe the difference on Vectra 3D imaging which can show the changes with specific implant styles and sizes on a three dimensional image of your chest.  It's a great way to help make this difficult decision.

Considering you have a DD-cup breast size with a 350 mL overfilled implant you must have medium sized breasts baseline.  You have two very good options for obtaining your goal of a less droopy C-cup breast.

Option 1: Deflate your current 350 mL overfilled saline implants in the office under local anesthesia then allow the skin to contract for 3-4 weeks (Simple procedure where using local anesthesia you poke a small needle hold in the implant and repeatedly draw out fluid until the implant is deflated).  Follow this with and implant replacement and tightening of the pocket (capsulorrhaphy) using implants in that are 100-150 mL smaller.  Since your skin is loose I would strongly consider changing to cohesive gel silicone implants (Allergan Natrelle Inspira Style SRF, SSF or SCF) which help decrease the chance of ripples.   With the contracted breast skin a breast lift can often be avoided.  If necessary, I reinforce the pocket with GalaForm Mesh.  This is an absorbable mesh which is replaced by tissue 3-5 times stronger and helps thicken the typical pocket.

Option 2:  Remove the implants and replace them immediately with cohesive silicone gel implant in the same plane along with a periareolar mastopexy or vertical mastopexy to remove the loose skin.  This allows complete control of breast size and shape since the size and shape of the implant and skin envelope are all within the surgeons grasp.  In addition, Galaflex Mesh (absorbable reinforcement mesh) can be used to reinforce the breast lift.  While this approach gives the best shape overall and the most dramatic breast lift, it does result in additional scars which are usually thin lines which are not very noticeable.

I ask patients to stop alcohol "a few" days before surgery.  I avoid suggesting a specific number of days before because social activities do happen and it doesn't have much effect on your surgery anyway.  Having a couple of drinks 3 days before your breast augmentation will not effect your outcome.  On the other hand, I would suggest avoiding alcohol within 48 hours of surgery so you are maximally hydrated and feeling your best.

Good Luck with your breast augmentation!

There are four points in the healing process that are important:

1.  Incision Sealed at 24-48 hours - The incision is sealed and it is safe to shower.  

2.  Incision Healed at 1 week - If sutures are use, they can be removed.  Okay to begin breast massage.  If there is no redness or drainage the incision is highly likely to heal without any problems and is extremely unlikely to reopen.

3.  Ready for exercise at 3 weeks - At three weeks one can restart exercise except reaching very high, hanging from a barbell, or heavy upper body lifting 

4.  Ready for anything 4-6 weeks - The incision has gained strength and can withstand heavy exercise and any activity you normally take part in.

Breast Implant Replacement Cost is affected by the following:

1. Drooping or Sagging of Breasts:  Often with drooping or sagging the cost is higher because of the need for a breast lift or capsulorrhaphy (tightening of the breast pocket)

2. Hardening of Previous Implants:  The cost may be higher because of the need for capsulectomy (removal of the hard capsule around the old implants).

3. Malposition of the Previous Implants:  Capsulectomy and/or placement of  a supporting mesh or dermal matrix may be needed to improve the implant position

4. Desire to Increase Breast Implant Size:  Since a larger pocket is needed capsulotomy is needed which will increase the cost

5.  Rippling, Visibility of the Implant, or Thinning of the Implant Pocket:  Adding Galaflex support mesh or Acellular Dermal Matrix (ADM) to thicken pocket and improve decrease visibility may be necessary.  In addition, a using a cohesive gel breast implant will help alleviate this problem.  These implants are more expensive since they are newer.

6. Implant Choice:  A large variety of increasingly cohesive gel implants and implants of various shapes and projections are now available.  The newer more advanced cohesive gel implants improve results but also drive up the cost of replacement.

7.  If you only need removal of the old implants and replacement in the same plane without modification of the pocket, a breast lift or support mesh then the cost is less 


Considering all of the above factors I believe it is well worth the time, effort and cost to see a board certified plastic surgeon who will examine you and create a thorough plan for you implant replacement.  Based on this plan the surgeon or his coordinator will discuss the cost in great detail  Indicating expected cost by phone is very inaccurate because of the above factors.  Good luck with your replacement surgery