Derek Rapp, MD

Thank you for your question.

The implants you have indicated are very similar. There is a slight difference in projection that probably isn't going to make a major difference in appearance. I would say that in general, I prefer full (#1) or moderate (#2) style implants to Extra full (#3). I think the geometry of these styles works well with most women's bodies.

In my opinion, the extra full is for someone who is trying to get maximum volume and projection. In order to get the highest volume with the narrowest base width, the implant has to be the most round. The reason I tend to advise the full over the extra full is in some women this can mean the transition from native breast to implant in the upper pole of the breast can be a little more abrupt and therefore look less natural and more augmented. This is not necessarily a bad thing simply a matter of desired appearance.

I think a little information on implant sizing and how geometry influences the dimensions.

Many physicians prioritize the base width of the breast to serve as a general starting point for choosing implants. Volume can then be decided based on the ability of the tissue to stretch and the desired size. Thus, in the natrelle catalog you have 5 implants with a base width of 13.25cm. As the volume goes up, the projection increases because it doesn't get wider so greater volume can only be achieved with projection.

Example : all of these implants have base width 13.25cm

low profile plus (SRLP) 340cc projection 3.5cm
moderate profile (SRM) 405cc projection 4.4 cm
Full profile (SRF) 520cc projection 5.5 cm
Extra full profile (SRX) 560cc projection 6.3

I think both are likely good options for you. you should speak with your plastic surgeon if you still are unsure.

best of luck,

Dr. Rapp

Good afternoon

Thank you for your question. you should definitely be evaluated in person by a board-certified plastic surgeon.
Because you are so thin and fit, your rectus diastasis is causing your lower abdomen to bulge out. This is a common change following pregnancy. This can only be addressed with a mini-tummy tuck approach so that the muscle accessed and repaired. With that completed there will likely be a little bit of skin that can be removed. Sometimes the diastasis is significant about the bellybutton as well and there are several ways to potentially address this issue. Some involve re-siting the umbilicus others without moving the umbilicus. pros and cons of both approaches can be discussed.

In regard to your breast surgery, you appears to have minimal ptosis (sag) so a simple breast augmentation with implants is likely to give you the volume and shape you are interested in.

Revision breast surgery is by definition more complex than primary surgery. As always, would recommend a board-certified plastic surgeon evaluate you.

Depending on several factors, you may be a candidate for simple capsulorrhaphy without repeat lift. if you have very large implants and/ or thin skin, I might consider placement of a bioabsorbable mesh such as galaform to reinforce the closure. If there have been several years since your surgery or significant change in weight you may require some skin removal .

In general, I would recommend you discuss the issue with your surgeon. Most of us appreciate the opportunity to fix the issues our patients have. I would not necessarily expect this revision to be free of charge unless this occurred within the first 3 months of surgery. sometimes a patient's tissue stretches more than you expect. this is not necessarily a failure of your surgeon so much as an unexpected result based on your personal anatomy.

best of luck!

Dr. Rapp

Based on your post, I think your PS has outlined a safe appropriate and conservative plan. smaller implants and conversion to silicone will decrease the risk of repeat bottoming out. you could potentially add some upper pole fat grafting to help give you the fullness you are looking for. That being said, I think you could address the bottoming out in another fashion. you could close the pocket inferiorly and laterally and place Galaform mesh to reinforce the repair then place a silicone implant (Gummy bear high profile if you want the most upper pole with least wrinkling and are willing to have firmer breasts). This would allow you to increase your breast size with less risk of recurrent bottoming out.

As always, you should consult with a board certified plastic surgeon if you are considering surgery to change your breast shape. 

your breast are most definitely normal.  some women have nipples that point a little more outward than others.  you can sometimes adjust nipple position slightly with breast lift techniques, but that does put a scar around the nipple and you have to be careful not to move the nipple too far away from the center of the breast mound.   The nipple is meant to be centered over the mass of a breast. if your breast is a half circle you want the nipple at the most projecting central location. Some women have breasts that are a little wider or set to the sides a little on the chest wall.  Be confident in your self, you are normal.