Donovan Rosas, MD

Based upon your photos, there is no evidence of symmastia. Given your small breast size you have reasonable cleavage. Symmastia is defined by the absence of cleavage either because of lack of separation of native breast or ill defined borders of the dissected pre pec augmentation pocket. If you are seeking to accentuate the cleavage you have, an augmentation is a reasonable approach. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Given a particular breast width, increasing implant profile will deliver greater volume and greater projection. With regards to your specific question, a higher profile device will give a more dramatic appearance. Submuscular/dual plane augmentation will flatten the effect to some degree. Your stated breast width is not particularly narrow and allows you to consider wider profile options (Moderate/Moderate +). These will deliver a more understated and subtle result for a given diameter. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Muscle spasms are common after submuscular/dual plane augmentation. They will typically resolve in the early perioperative period and are easily managed with prescription muscle relaxants. It is encouraging that you appear to be improving. Momentum is often important in these sorts of issues. However, the persistence given your history of issues on the left warrants at the very least clinical surveillance. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including: -Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing. Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look. -Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term. -Patient desire (what is the look you are hoping to achieve?) My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire. There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa. Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." With regards to your specific question, if you are seeking a noticeable upsize, 100 ml at least is recommended. Your plan seems reasonable. You will gain greater upper pole fullness and can simulate greater cleavage in a pre-pectoral plane. Communication is key as you and your surgeon create your custom surgical plan. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Based upon your photos, you have a very mild pectus deformity (if at all). Pectus is the most common congenital chest wall abnormality characterized by a depression of the lower costal/rib cartilage. If there is a deformity, it unlikely to be severe enough to influence your result. That being said, a pectus deformity will not disqualify you for breast surgery. However, certain considerations will need to be taken preop. The implant is seated on your chest wall. Pectus can affect position, shape and cleavage. This need to be taken into account when planning/selecting implants. It is also important to realize that regardless of the measures taken to offset the deformity, there is a limit to what can be accomplished. The chest wall shape will always have an impact on the appearance of the breast. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

The cause of the contracture remains unclear, however, the prevailing opinion is that it is a consequence of irritation/inflammation. It is a progressive process that takes months to develop. It can begin with a subtle change in firmness progressing to visible distortion and eventually becoming painful. While the rate of capsular contracture, historically, has been quoted as high as 30%, much has changed over the years leading to a precipitous decline in the incidence. These developments include: submuscular placement, the use of 3x antibiotic irrigation, cohesive gels, "no touch" techniques utilizing a funnel device, fold incisions. Based on your photos alone, it is difficult to say for certain whether you are in fact dealing with a capsular contracture. Without an in-person exam, any evaluation would be pure conjecture. As always, discuss your concerns with your board certified plastic surgeon (ABPS).

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including: -Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing. Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look. -Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term. -Patient desire (what is the look you are hoping to achieve?) My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire. There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa. Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." With regards to your specific question, differential profiles is not uncommon. Breasts are sisters...not twins. There may be variations in size, shape, sag. At times, the best way to address asymmetries is with implants of differing width and projection. Ultimately, a different profile is no different than an implant of different size within the same profile. Implant selection will always take into account volume but also width and projection. Communication is key as you and your surgeon create your custom surgical plan. As always, discuss your concerns with a board certified plastic surgeon.

Capsular contracture is a function of inflammation. There is no strong evidence for the use of peptides or US in this setting. The only proven treatment is implant removal and capsulectomy. Implants can be replaced but the risk of recurrence is elevated. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both. There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision. A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred. With regards to your specific question, you demonstrate some mild glandular ptosis or sagging. Your nipple position is preserved. A mastopexy/lift is not absolutely necessary. A pre-pectoral (larger) augmentation may be adequate to deliver upper pole fullness and camouflage the mild pseudoptosis. There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

It is important to remember that your result will change over time. It is especially susceptible to weight changes/pregnancy. It is difficult to offer any advice given a single post op photo. This does not offer perspective on where you started pre-op or what the result looked like immediately post op, 6 months post op. The photo demonstrates some asymmetry of volume and position. However, it is impossible to say whether this is evidence of the changes associated with time/weight loss or device migration (or both). Regardless, there are always options for revision. As always, discuss your concerns with a board certified plastic surgeon (ABPS).