Bottoming out Revision and Downsizing?

Hello! I'm 6 mths post op. 5.6, 120 lbs, 29 ribcage, 27 waist,35 hips, slim legs. I was a full, slightly saggy 34B, wanting a fuller, perkier look. My dr suggested saline unders, mod,350 ccs filled to 405. i'm now 34D/DD. Nice result but a little too big & bulky for me. My left bottomed out & falls to my side. I want a less bulky look & more natural feeling breasts. My Dr suggested silicone 300 cc or 250 cc, is this better?

Doctor Answers 12

Breast Augmentation Revision?

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Thank you for the question and pictures.

Overall, you have a very nice result. To achieve your goals you may to downsize your breast implants as you describe and closing off the breast implant pocket ( where the breast implant falls laterally).  The exact breast size/model/profile is be best determined intraoperatively by your plastic surgeon after you communicate clearly with him. For this purpose I prefer the use of goal pictures.

Best wishes.

Breast implant revision, smaller size?

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You look like you have a good result, but if your breasts are larger than desired, you can have them replaced with smaller implants.  A 100cc reduction in implant size should give you a noticeably smaller breast, but you should discuss with your surgeon what your goals are, and maybe even show him some photos of breasts whose size you like, and he can help you decide how much smaller to go...whether to 300cc or even 250cc.  Also, saline implants tend to feel a bit firmer and often appear more prominent or more projecting, so considering silicone gel implants might be helpful as well.

Revision breast implant surgery

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Your surgeon can switch to gel implants that are a little smaller and revise the pocket on the left side to close it a little. That should give you the result you want.

Good luck

Ernest D. Cronin, MD
Houston Plastic Surgeon

Revision Breast Lift plus Silicone Implants can improve your results!

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You have both an excellent result, and legitimate requests for smaller volume and more natural "feel." Your present 405cc saline implants will need to be reduced to around 300cc to notice a definite size change, and that will only be slightly less than half a cup size (since it takes about 250cc to equal one cup size). Anything less than 60cc (two ounces or 4 tablespoons) will NOT be visible. Too much and you will have excessive movement and overly wide cleavage, which is a different kind of unnatural feel and appearance.

The newest cohesive silicone gel implants (Memory Gel by Mentor, and Natrelle by Allergan) are both state-of-the-art implants, and cannot leak or rupture, and have the most natural, soft, and non-rippled "feel." You will need moderate profile implants, which have the greatest width for specific volume, which will help both the cleavage and implant movement issues. At your height, I would suggest the 300cc implants, but you should agree that the change in size will be a subtle one. I would worry that the 250cc implants (even in moderate profile) will bee too narrow, giving overly wide and unnatural cleavage, not to mention excessive movement in your pocket (like a golf ball in a bowler hat, to give a mental image).

If you do not like how your left implant moves to the side when reclining, this can be addressed from the inside by performing capsulorrhaphy (pocket tightening), which will also benefit the smaller implants by not allowing excessive and unnatural movement. The same thing can be done to raise the left side if it indeed has bottomed out, or the right side can be lowered slightly for better symmetry. Either is a proper solution, though gravity is a constant factor, so raising the left may be slightly more difficult to maintain, but better for the long run! Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Switching from Saline to Silicone Breast Implants

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I agree with others that you have a preexisting asymmetry with a shape and size discrepancy between your left and right breasts.  This would require different size implants to be placed in order the help achieve a better symmetry.  In most cases, silicone implants give the most natural result.  I would suggest exchanging the implants to a slightly smaller size and to use silicone implants.  In most cases, the implant exchange surgery is must less involved than your original surgery.


Good Luck.

Revision breast augmentation is usually successful.

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1)  Just going by your picture, you do not have bottoming out of the left breast.  The asymmetry seems to be caused by your shape before surgery and by the right breast implant pocket being too high.

2)  I think you probably need a slightly smaller (about 25 cc's) breast implant in the left breast than the one in the right breast.  Now, the left breast looks bigger.

3)  Silicone gel breast implants usually feel more natural than saline filled breast implants.

4)  300 cc breast implants are probably a good idea, but the decision should not be made in advance.  Your surgeon can put sterile implant sizers in your breasts (just like implants but disposable) to actually see what a particular size looks like.  Otherwise, it is just an educated guess.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Your breasts were uneven after lift and will be after augmentation

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Based on your before pictures,you had very uneven breast shape and size after lift. Implants can only add volume to the breast and will not even out your breast shape. If would recommend mastopexy revision after implant exchange.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Bottoming out Revision and Downsizing?

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Thanks for the photo series. Six months postop is long enough for you to determine your satisfaction or dis satisfaction. I find your result very acceptable but if you desire revision than at least switch to HP implants for more projection less width. Down sizing to 300 cc makes sense and close the left lateral and inferior pocket. Best of luck. 

Revision breast surgery

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Do not get hung up on the volume. Part of your problem, I think, has to do  with dimension. If you used a lower profile (sometimes called moderate profile) then cc for cc they are the wider style. Width also relates to height if you are using round implants. Your original breast are shorter than they are wide. Therefore, an implant that fits your width, might give you too much height, producing the bulky look. Also, the wider you go the more the implant will "fall" off the chest becasue the chest is convex. because you ahve a decent size and amount of natural breast, you might want to measure your "natural" width and pick a lower profile implant or even slightly less wide, that fits that dimension. If the subsequent volume doesn't give you the increase you want, consider the next higher profile, not increased width.  Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Revising breast implant size

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Switching to silicone implants should provide a more natural feel, and selecting a smaller implant (with possibly a lower profile) will decrease your breast size and make the contour a little more natural.  You have a nice result, and your left implant "falling to the side" is likely the result of some natural asymmetry, which is also visible on your pre-operative photo.  Switching your implant will not prevent your left implant from falling to the side when you recline; treatment would require some form of pocket revision.  You should discuss these issues in detail with your surgeon, to confirm that the changes you will likely see after a revision would be significant enough to justify another procedure.

Good luck.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You should continue to follow-up with your plastic surgeon in order to receive a formal evaluation and maintain your doctor patient relationship.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.