I think it would be worth looking at why you find yourself where you are at now before addressing some of the other specific parts of your question. In 4/15 you had a single stage augmentation plus lift with a moderately large implant on top of the muscle. Now, not only do you have capsular contracture, but your implants are significantly bottomed out and your lift scars are not good. It is widely recognized that the simultaneous combination of lift with implant is a very difficult and high risk procedure and is associated with a very high complication rate (30% or more). There are multiple reasons why this is the case, but very often either one or both of the procedures need to be revised. For this reason many surgeons will recommend doing the procedures in stages to avoid the kind of unsatisfactory outcome that you have experienced. This type of outcome is far too common and your surgeon should have discussed with you that this combination of procedures in you had a high risk of needing a revision.
In addition, your relatively large saline implants were place on top of the muscle. This can be a significant problem as well because the breast tissues alone are often not able to a support the weight of the implant and consequently your implant will bottom out as yours have done. Finally, the risk of capsular contracture is elevated with implants on top of the muscle and you have developed that problem as well. So unfortunately you now have a very difficult set of problems to correct.
It is a common misconception that upper pole fullness is simply a function of implant size or profile. It has at least as much to do with implant position or location on your chest wall, so a bottomed out implant will necessarily look "saggy" without upper pole fullness. It is also meaningless to show wish pictures of individuals in a bra. This person could look like you with their bra off because it is the bra that is creating all the upper pole fullness.
I would agree that switching your implant to under the muscle would be an important component to addressing your problem of capsular contracture. I would disagree with the large increase in size to 650 cc. Again, it is not just about having a large implant to create upper pole fullness. Also, if your tissues failed to support a 450 cc implant, why is it that you would imagine that a much larger implant wouldn't bottom out as well, thus leaving you again without upper pole fullness. You should really focus your energies on finding a surgeon who is very experienced at revision breast surgery and try not to ask for things which really end up being contrary to your goals and long term results.
It's a good question, but the reality is that an implant that large is a set up for having another problem.You mentioned sagging of your breasts, and it appears from your photos that there is stretching of the lower pole of your breast. The distance between your crease in your nipple appears too long. Your skin has already been stretched, and adding a large implant will only make the problem worse. Your skin will certainly stretch again and you'll be addressing the same issues, but tissues will be even thinner and further stretched.I would consider having a frank discussion with your plastic surgeon. You should discuss the best ways to achieve an acceptable result that is long-lasting. You could consider use of an internal sling to help support an appropriately sized implant, so that your skin does not have to bear the full load.
Hi AF,Thanks for your question and photos. Most women want exactly what you have described but reality and wanting are two different things. No one can promise you that your implants will stay up high unless you get capsular contracture under the muscle. Implants typically have higher capsular contracture rates over the muscle and less under, but there is never a real guarantee one way or the other. You chances of having another capsular contracture are higher even after a revision and going bigger increases those chances even more. I think going under the muscle is a good idea but not sure about the size increase. A redo lift will be necessary but you may consider having a biological tissue matrix place(internal Bra) which can help support your implant better and decrease the chances of CC. It is the best thing we currently have a preventing CC currently. Good Luck!
All the best,
Carlos Mata MD, MBA, FACS
#CC #breastlift #breastaugmentation
Board Certified Plastic Surgeon
When I see a patient in the office with a question like this, and it's common, I feel it is most important to help the patient with a reality check. On the surface your thoughts sound like they might work, but in actuality they don't. The strength and elasticity of your breast tissue were bad enough that a lift was needed. Then you challenged the lift with a heavy implant and got what we should know would be a predictable result with further stretching out of the skin. Now the plan is to add 50% more weight to the skin. The skin quality has not improved and the law of Gravity is predictable. The problem will only get worse. The only option that might work is to build up internal support with ADM and even then it does not always work the way you hope.
I appreciate your question.
The best way to determine implant size is based on chest wall measurements that fit your body. Once we determine that we can choose the profile based on what you want or need to achieve.
Implants under the muscle, there is less risk of capsular contracture. Anatomic implants tend to give a more natural shape with more nipple projection.
The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
Best of luck!
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute
One of the common problems I encounter is the patient who wanted a high round appearing breast and underwent a breast augmentation with the implant on top of the muscle. Although they may look good initially, there is nothing to support the implant on the chest wall and the implant invariable drops with time. The skin envelope just isn't strong enough to support the weight of the implant and skin does what it is supposed to do - it stretches. In your cases, I would re position an ultra high profile implant under the muscle and also improve your mastopexy incisions. By placing the implant under the muscle, it will remain in a much higher location and be more stable. See "Long term changes associated with implants on top of the muscle" in the link below. Best of luck to you.
Thank you for the question and pictures. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures and direct examination/communication in front of a full-length mirror) will be critical. Keep in mind as you are thinking about your goals that sometimes adjustment of the breast implant pockets (capsule adjustments AKA capsulorraphy AKA "internal bra") may be necessary to achieve the outcome you are looking for.
Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "D or DD cup” or "fake look" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery ( after the use of temporary intraoperative sizers). Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select the best breast implant size/profile for the specific patient.
I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps.