I wanted a lift, my Dr put in small implants instead to achieve volume up top. Nothing fits &t hey are too big,4 months post op.

I'm 5'3", 115 pounds and came to my Dr. wanting a lift. I had a reduction in 2000, going from a 34DD to 34B. I wanted to have more volume/cleavage on the upper part of my breasts. My Dr. recommended putting in a small implant. We chose 265cc, silicone implants. Post-op, my breasts are back to the same size before my reduction. We decided to switch out my implants for a smaller size (he's thinking 180cc) but now he says I will not have any fullness on top. That was the entire goal! Please help.

Doctor Answers 4

Implants After #BreastReduction

From your description, it seems the implants failed to achieve your goals. The issue here is likely expectations. Women who have larger breast to begin with rarely are able to achieve small, lifted and full breasts (especially on top). This is related to anatomy and skin quality and elasticity. A photo could help to further define your issues, but not every woman can get "exactly" the look they want. We must respect your preexisting anatomy and body shape. Perhaps consider fat grafting to locally add volume to the upper pole of the breasts. 

Continue to follow up with your surgeon to ensure that you progress as planned.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon

San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Fullness on top

This is a problem with a lot of women.what I do with my patients is to recommend some fat bgrafting to the upper part of the breast and along the sternum.You get fullness on top,cleavage and you get suctioning to an area of your body that has excess fat.A win win.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews

Sometimes implants are used for "fullness" and not just volume

I understand exactly where you are coming from, as this is a very common situation in ladies who either have had breast reduction or lift procedures in the past and now lack volume in the top of the breasts.  While it sounds like your surgeon didn't listen to what you wanted, in reality, I think he really did and tried to do the right thing and create the result you were looking for.  You wanted more fullness/volume and cleavage on the upper part of the breasts, and the reality is that the only reliable way we have to do that in situations like this is usually with a small volume implant.  While all surgeons can find that uncommon instance in which the breast tissue has great tone and cooperates with us well with just a lift or reduction alone, most of the time when we are doing lifts and reductions, the tissues don't maintain their tone and fullness at top, they settle to the bottom of the breast mound, and the upper pole still looks deficient.  Thus, while it sounds counterintuitive to put an implant in a lady who has had a breast reduction in the past, or in whom we may even be doing a breast reduction/lift at the same time, the truth is that I frequently do it this way.  The reason is just as I stated above - I'm using the implants for FULLNESS and not so much for volume.  I know this sounds like splitting hairs, but the distinction is real.  Think of the implants in this setting more as a "splint" or a "mold" to form the breast tissues and create a full shape ("fullness") as opposed to something just put in there to create brute force volume, or size.  The trick here is to get the NET FINAL volume and shape of the breast to be what we want.  This requires a bit of artistry to balance the removal of appropriate amounts of breast tissue from the appropriate places in the breast with the size and projection of implant to best create that desired breast shape and volume.  When this doesn't happen, it's more because of a lack of this balance than it is the underlying plan.  From the sounds of things and without examining you myself, I think I would actually agree with his basic approach to consider an implant.  It sounds like you just need things adjusted a bit, just as you are discussing with your surgeon now.  This may entail simple replacement of the implants with smaller ones, or it may be better to do further reduction of breast tissues allowing you to retain some volume and projection from implants which will not settle and lose tone like breast tissue will, or some combination of those two.  In the end, however, the key is still that all-important balance I mentioned.  Continue to discuss your goals with your surgeon openly and listen to his feedback.  If you feel you need a second opinion, get one, as sometimes that can help solidify a plan or offer fresh perspective.  Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 87 reviews

Not happy with results

What you have described is very common in patients who have very loose overlying soft tissues and skin that have been stretched out by heavy breasts and /or implants. The plan your plastic surgeon has come up with is probably what most of us would do knowing that the amount of breast you have, even when moved upward would not be enough to give you the upper pole fullness that we would think you want. Another option might be to add fat grafting from the hips and abdomen just to the upper pole to give a little more tension and fullness. The implant could also be removed and the skin tightened again with more vertical tension, somewhat overcorrected so that these don't bottom out so quickly. Those are just some thoughts, I think you should discuss this with your chosen plastic surgeon. Good luck., I

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

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