300cc, high profile, silicone, what type of revision can I have that will help my breasts? (Photo)

Question

I had my breasts done several years ago (2021) I really liked them at first, but that was only because I had almost zero breast tissue so any implant was an improvement and a boost of confidence. However, my breasts never dropped or fluffed, they sit extremely high on my chest and they’re not soft. They’re not “hard” but they’re not soft or fluffy. They have almost zero movement, they don’t bounce, or shift. My implants are 300cc high profile silicone. It looks like I have pecs.

Daniel Barrett, MD · Answer

Dear cheekylilvixen,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

John Michael Thomassen, MD · Answer

A mild to moderate capsule can make the implants stiff and sit high on your chest wall.  A revision with new implants and partial capsulectomy can correct this.

Gary M. Horndeski, MD · Answer

Your 300 cc implants may be too large for you. You may be better off with smaller implants and a circumareola approach to reposition the nipple-areola complex slightly higher and perhaps more medial, if that is what you desire.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

Your implants are too large for your frame and tissue. I would suggest going smaller, but keeping the implants behind the muscle. I would suggest going down between 200-250 cc's.  Also, your profile is too high.

Mats Hagstrom, MD (license on probation) · Answer

Generally speaking, there are three variables that determine breast augmentation outcomes.
The first patient candidate see, the second is implant selection, and the third is the ability for the surgeon to put the implant in the correct anatomic location.
Your implants are substantially wider than your natural breast diameter.
Your surgeon did not open the IMF (infra mammary pocket) Which in my opinion is a good thing.
That leaves the implant no place to go but to sit high since you’re implant has a bigger diameter than you’re natural breast.
The easiest way to get a natural looking breast that doesn’t write high is the lower the size of the implant specifically with a lower implant diameter.You can try to make a bigger breast diameter, but this needs to include opening of the IMF.
When the IMF is opened, allowing the implant to ride lower the patient patient is at risk for “implants bottoming Out”. This is a highly undesirable outcome and should be avoided.
In regards to candidacy I think you were a good candidate for breast documentation.
In regards to anatomic placement of the implant I think your surgeon did fine.
Perhaps they could’ve gone just a little bit lower and still be safe, but I don’t think it was done poorly.
I think your problem is related to implant selection.
 Assessment that we generally need to see a complete set of proper before and after pictures.
If you don’t have it before and after pictures, then you should ask your provider to forward the pictures they took.
Did you follow up with your plastic surgeon? What did he or she have to say? 
You do have slight divergence of your breast, but I don’t think it’s that significant.
Either follow up with your provider or schedule a few in person second opinion consultations with other plastic surgeons in your community.
For second opinion consultations come prepared to bring with you a complete set of proper before and after pictures and a copy of your operative report.
The part of your medical record and you can request them from your current or previous provider.
Having implants that ride high is much better than implants that end up bottoming out.
Correcting implants that it is easy and straightforward.
Correcting implants that have bottomed out is very difficult and can lead to more complications.
Having revision surgery after breast augmentation is not uncommon. Period probably 25% of patients and up having a secondary procedure within the first five years.
Selecting excessively large implants will always lead to increased undesirable side effects, increased complication rates and increased need for revision surgery.
And more modest augmentation would have been more ideal, but implant envy is very real, and a lot of women simply want bigger implants.
I generally recommend people rely exclusively on in person consultations and generally avoid virtual consultations whenever possible.
Best,
Mats Hagstrom MD

300cc, high profile, silicone, what type of revision can I have that will help my breasts? (Photo)

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