450cc Hp Implants Too Large for Frame, Need to Downsize Before Lift Compromised

Question

I had anchor lift/aug 2.5 mos ago wanting a full c/small d cup. My ps put in 450cc hp while on the table "to fill up my skin" as others didn't look right? I KNOW I am too big given it's been 2.5 mos and measuring a DD. I want to downsize before lift is compromised. I'm 5'6" 116lbs. 32/34 band. Pre-op deflated small c from breastfeeding. What will provide good cleavage(gap is wide as well)and proportion for frame for full c/small d. The initial 450cc hp is obviously not right and need help!

Scott C. Sattler, MD, FACS · Answer

I would allow your tissues to heal for at least 6 months before attempting a revisions of your mastopexy-augmentation combination. A smaller implant will fit your chest better and probably look better over the long term. You may need a revision of the mastopexy if you choose an implant that is substantially smaller than the 450 cc you have now. Breast skin will contract a bit around a smaller implant - assuming your breast skin is good quality.

Tom J. Pousti, MD · Answer

Much of the final &ldquo;look&rdquo; achieved after breast augmentation revisionary surgery  depends on several factors:
	1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation &ldquo;look&rdquo; will be optimal.
	2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
	3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
	On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
	Other differences involve how the breast implants are filled. Saline implants are filled after they&rsquo;re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
	On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers&rsquo; saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
	4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; 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 breast 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 &ldquo;I wish I was bigger&rdquo;. I hope this helps.

David Bogue, MD · Answer

I would agree with you that your implants are bit too large for your frame. Decreasing the size of the implants is not difficult, but you may need a revision of the lift at the same time depending on how much smaller you wish to go. When I perform an augmentation mastopexy, the implants are placed first, then the lift is tailored to the new augmented breast. This allows for a more predictable and a safer outcome. In using an anchor scar to perform the lift, there is should be no need to change the implant to fit the lift, but rather remove the skin until the lift fits the implant. I recommend seeking a second opinion from a Board Certified Plastic Surgeon if you like, but a revision surgery is in your future if you wish to change the result.

Robert Brueck, MD · Answer

I agree you are big foer your body size and putting smaller implants in would be nice.I think you cleavage has to be carefully measured so that you don't get symmastia and that is tough to correct.

Steven Wallach, MD · Answer

I think that you have a very nice result, but if you want to go smaller, them you may need a revision of the skin envelope as well. Being that you are only 2.5 months out from surgery, you may want to wait a few more months to see how they look. Going smaller with a wider implant of say a mod + or moderate may give more cleavage and less projection.

Darryl J. Blinski, MD · Answer

Thanks for the postop photo series. A before photos posted could help. I recommend to wait at least 6 months to allow settling and full healing. In my opinion, based upon only the post op photos, I believe you have a very acceptable result. You need in person discussions with your chosen surgeon, please, include a discussion of realistic expectations. So you can better understand possible results and the risk/benefit ratios of further surgery.

Craig Harrison, MD · Answer

Dear Suzic,

	Best to speak with your PS sooner than later.  Waiting three months is acceptable before a revision.  Choosing the "best " volume is a difficult endpoint to define preop.  Exactly what volume will be best may be easier now that you see what 450cc yields for your frame.  Cleavage is not produced by implant but is more determined by your underlying anatomy.  Communication with your PS is key to an acceptable result.   Good luck

Robert N. Young, MD, FACS (retired) · Answer

Judging from the pictures you posted you probably need a narrower and smaller implant.  They could also be brought together a little more.  I would recommend around 300-350 cc.

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