My wife had her first breast augmentation over 3 years ago, from an A to small D. She had saline sub-muscular implants. They seem to have slowly gotten smaller in the last 2 years, and seem extremely far apart and a lot lower. Can the pockets be corrected, and moved closer together for more cleavage? She wants gel silicone implants due to not liking the "bag feel" of her implants now. She also wants to be a DD, or possibly a DDD if it's possible, but she is concerned that her breasts will look "see thru". Any advice?
Pocket Correction with Bigger Breast Implants?
Doctor Answers 8
Large saline breast implants
From your description, her implants have already bottomed out and are laterally malpositioned. A size increase from A to D is considerable.
This is actually a common occurrence with large breast implants. Going larger may temporarily solve the problem, but pocket repairs, especially when larger implants are placed, are notorious for failing, and the deformity recurs.
I personally will not do a capsular repair in such a case unless the patient simultaneously agrees to place smaller implants. I've seen too many cases requiring redos, lifts as a result of the stretched skin and the "see thru" deformity you describe.
Redos can be difficult
Without seeing what you are seeing, specific advice is not possible. In general, women have the tendency to desire larger implants after a few years. It can be done but as you get larger things do start to look differently. You might benefit from a breast lift as well.
You need to see your surgeon and figure out what you want and what can be done. There are limits but usually options as well.
Meet with your plastic surgeon
The pockets can most definately be corrected but this has to be done carefully if larger implants are being used. The space between her breasts is many times dependant on where the muscle attaches to the breast bone because we should never disattach it there. If her plastic surgeon states that they are as close as they can be together, this is probably the reason why. For what your wife is trying to achieve, silicone sounds like a good choice.
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The shape can almost certainly be corrected.
I would really advise strongly against very large implants, even though it sounds like your wife needs a revision to improve shape. Very large implants (DD or DDD) cause the skin to thin out and stretch, and they age very badly. Also they have more complications, such as loss of nipple sensation.
Going that much bigger will cause the problem to recur over time
Going from a D to a DDD spells a lot of trouble-- the skin of the breasts can really only take so much pressure and stretching, and over time, the bottoming out that your wife is experiencing will recur. My recommendation would be to maintain the same volume/size of the breasts or even a bit smaller-- this will allow your surgeon to control the fold and pocket of the implant in a more precise manner.
Going larger defeats the purpose of the repair
Bottoming-out and lateralization of the implants can be corrected depending on the severity and the cause. In some instances a modification of the pocket will be sufficient, however, if there is excess skin, then a breast lift may be required. The problem with adding larger implants is that it will defeat most attempts to lift the breast.
Can be corrected
The pockets can be surgically corrected, no problem. The "see through" part, I am not sure what you are referring to, however I assume it relates to stretching. An exam will confirm this for you.
What has to happen is the implants must be removed, and the capsules must be imbricated, or stitched on the lateral and inferior aspects so that the implants are moved to the midline and up.
The larger the implant, the more likely that the pocket will stretch in the future.
Silicone implants are heavier than the corresponding size saline implants, but tend to form a more natural result.
This is a formula for disaster
As Dr. Moelleken has said, repairing a pocket that has bottomed out is difficult especially if you want to go larger. Gravity will almost certainly destroy the repair. I would never offer you this option.
You could possibly stage the procedures by removing the current implants and repair the pocket and let them heal for 4-6 months and then go back in and place larger implants. Even these however can bottom out again.