Drew A. Kreegel, MD

Dear Latinx8,

The question of revising your breast augmentation and lift depends on multiple factors. The desired breast size is of course determined by both the starting amount of breast tissue/size of your breasts before the augmentation plus the size of the implant. The size of the implant chosen should be that volume which will produce the approximate final breast size you desire, assuming it's realistic. During surgery the implant is typically inserted first and the back of the surgery table is positioned upright so the breasts can be evaluated in the natural position. The type and extent of the breast lift is then designed so that there is elevation of the entire breast and the nipple is located well above the lower fold of the breast. The augmented and lifted breast should fill the upper breast pole flattened hollow area above. The size and type of implant chosen is based partly on the measurement of the widest part of the breast so that it does not bulge excessively at the sides. There are various styles of implants such as moderate profile, full profile and extra full profile. The advantage of using a full profile implant is that when compared to a moderate profile implant of the same volume, the full profile implant is narrower at the base and can give the same amount of increased breast volume and greater forward projection (perkiness) than the moderate profile implant. This makes the cleavage between the breasts also somewhat deeper. For patients who desire a large increase in breast size but are limited by the horizontal width of their chest and breast, I find that a full profile implant is preferable. For patients who are small frame and petite but want a large increase in breast cup size an extra-full profile implant can have the same volume size but in an even narrower base and space limitation.The type of lift used is determined by how much the nipple-areola and breast need to be lifted and how much excess skin is required to create a smooth and not excessively full lower breast pole curve.

A recommendation as to what lift ,if any, you may need is based on the breast size, position and shape you prefer. Most people and plastic surgeons prefer a natural but enhanced breast with larger size, better position,  better shape, correction of sagging, filling of the area above the breast with a more round contour, greater perkiness and deeper cleavage. Some patients, usually in the younger age group actually prefer an exaggerated  "more than natural " breast look.

Too make this decision good communication with your plastic surgeon is essential so that you both are on the same page about all of the features discussed above and your realistic goals.

As to the scars I would definitely wait a full 12 months to complete the scar maturation process before judging the final outcome.




It is important to understand that an in-person examination, a good understanding by the plastic surgeon of your goals and by the patient as to what is realistically doable and review your photos taken prior to the surgery in question are necessary to make any reasonable recommendation.  I hope this is helpful in your consideration of any breast revision surgery.

Best wishes.




Drew A. Kreegel, MD, FACS

Miami and Ft. Lauderdale, Florida

Hi Ms. 7799,

Most importantly you should make your final decision about improving your breasts not by reading these answers but only after a real in-person consultation with a plastic surgeon.Your breasts appearance is not as unusual as you might think. The fact is most women have some degree of breast asymmetry both less and more than yours. Perfect symmetry is not a realistic goal for most patients and "normal" is really a spectrum of breast appearances and also a function of a patient's personal ideal. 

It is notable how closely similar the body type of the person in your "wish pick" is to yours. I think an appearance very similar to that pic is doable. The "constricted breast" has certain features that plastic surgeons use to classify a breast in that category. I don't think your breasts fit that formal description. The left breast does have some "constriction or tightness from the nipple to the fold below, meaning that the distance between those two points is shorter than usual making the lower part of the breast appear tucked in and upward tighter than the opposite breast. This causes the breast, fold and nipple to be higher than the opposite one.

 AC solution is to lower the left fold and place a larger (than the right side), preferably silicone gel implant below the muscle to improve the match in size and volume. After these steps and during the same surgery the left nipple will likely still appear higher than the right side, in which case a small lift of the right nipple can be done to achieve better symmetry. Keep in mind that sometimes in cosmetic surgery there there can be more than one correct way to achieve similar results. So the way one plastic surgeon recommends may be a somewhat  a different approach than another.

I think you will be much happier  with your breasts after surgery.




Drew A. Kreegel, MD, FACS

Miami /Ft. Lauderdale, Florida

Dear Vivi,

It's important not to make the decision about breast implant size on your own. Even if you have diligently researched the subject it is important to work in partnership with your board certified plastic surgeon. He/she will assess the technical factors that are involved with your specific body type and breast configuration and explain how best to obtain your cosmetic goals. This can only be done accurately in person and cannot be done adequately with just a few photos of the breasts only, to make the best recommendation tailored to your case. It is not uncommon for patients who come in with a pre-conceived notion about having very small implants and later on disappointed with their breast size. I find that with some patients there is a process of change in self perception when initially they may feel too big because the pesence of implants feel foreign and there is an unfamiliar body image when they look in the mirror. Over time it seems that the look and feel are incorporated into there own body image and the new breasts become just a natural part of their body like any other body part. I hope this may help you with your experience.

Good luck.

Drew A. Kreegel, MD, FACS

Miami, Florida

Dear felixthekitten,

Most plastic surgeons will have their patients remain off the buttocks for a variable lenght of time following BBL. When the fat is transfered to the buttocks it is in simplest terms like injecting tissue with the consistancy of say like toothpaste, where it can be forced to move around in the space in which it is contained, the fat layer below the skin. As the early healing process is happening the consistancy of the fat tissue becomes more jello-like which resists change in shape and moving around. When the transfered fat healing process is complete the surviving fat cells become part of the fat layers below the skin, increasing the volume/size of the buttocks. As important is for the transfered fat tissue to stay where it is was originally placed to improve the shape of the buttocks also. 

In my opinion pressure should be kept off any area where fat was put including all areas of the buttocks - upper, lower & sides, for at least two and preferably three weeks to preserve the intended shape. It's a "pain in the b__t"  having to stay off your buttocks & sides while sleeping and wanting to sit. It's a small price to pay to have the butt and body you have wanted to have for so long.

Drew A. Kreegel, MD, FACS


Ft. Lauderdale & Miami, Florida

Sugarcie,

Most women have varying degrees of natural depression in the hip area before a BBL. Filling this area in to make the hip area rounded and curved evenly with the rest of the buttocks is usually one of the goals of BBL. The depressions  will very likely be corrected with transfer of additional fat. In my opinion I don't think you need changes  to other areas, unless there is any other area of "fine tuning" you desire. Hips aside, you have a nice result. CS

Ft. Lauderdale & Miami, FL