A few comments:
Round and high profile implants are not mutually exclusive. Round refers to shape of implant while high profile refers to dimension.
Because the teardops implants are textured, they will generally produce more rippling, especially if your over-lying soft tissue coverage is thin.
The most natural implants fit the natural outline of your breasts. If you go outside the periphery of your natural breast, or if you have so little breast tissue that the majority of the breast will end up being composed of the implant, the breast will end up resembling the type of implant you choose.
As for concavity of your chest wall, in general you will need higher profile implants to achieve a certain projection.However, the higher the profile , the more you require pressure to achieve projection, the more pressure on the underlying ribs and the more concavity will develop over time due to remodeling of the ribs themselves. Some times what patients want comes with a price.
Finally, projection and cleavage are different sides of the implant story. For cleavage without significant overlying soft tissue, you will need an implant width to produce the cleavage. Once you determine the width, you can see how much projection is required to give you the depth of cleavage you desire. It seems as if what you desire will come with significant side effects or possible long term consequences and you should prioritize your desires. It is possible that you will not find a perfect implant to give you all of what you desire.
Use Mentor round smooth walled implants
Hi! Several points:
1) Some of the problems you have (no cleavage, implants against armpits) are due to poor surgical technique and not to the implants. How the operation is done matters more than which implants you use.
2) Having said that, I have seen a lot of problems with textured, teardrop implants, and I dont use them.
3) Don't use "moderate profile" implants, because these are really low profile, and can cause rippling. You need either moderate PLUS profile or high profile, and this is determined by how wide your chest is.
4) To find out exactly what size implant will give you a large C-small D look, I use temporary SIZERS during surgery. We sit the patient up (you are under anesthesia, of course) and put different amounts of saline into the sizers, until we find the right volume. Then we discard the sizer, and use the permanent silicone implants of the right size. This takes all the guesswork out.
5) I am not sure what your chest "caving inward' means.
Smaller diameter, high profile silicone implants would be good
Without examining you, it is hard to give specific advice. Also, with having several previous breast surgeries, it makes anything more complicated.
However, I would suggest a narrower diameter but high profile silicone implant. This will help maintain the cleavage, but also reduce the amount of implant that is affecting you in your armpit.
Good luck with your surgery.
Teardrop Implant Replacement
If you are looking to remove your tear drop shaped implants, it may be safer to replace them with round implants, especially if you want a smaller profile. It is difficult to control the size of the pocket in a breast revision which makes the rotation risk higher if you’re exchanging with a shaped implant. It may be possible to use a new shaped implant if you’re planning on placing a larger implant.
Breast Augmentation Revision and Shape of Implant
In 2003 you would have had textured saline breast implants with a teardrop shape, and presumably you had the same type placed at the second surgery. Because the breast implant market has improved since then, you should see your plastic surgeon again to review the different types of silicone gel breast implants that are now available and what would be best for you. I rarely use saline breast implants anymore in my own practice.
Moderate Plus Silicone Implant
treatment of secondary breast deformities needs to be individualized and is
based on the patient’s specific anatomic findings and unique aesthetic goals.
It’s impossible to make recommendations without pre-operative pictures and a
physical examination. This is especially true when patients have underlying
chest wall deformities.
appearance of your breast has been impacted by multiple variables. These
include a pectus excavatum deformity, post-surgical changes, and changes
related to pregnancy.
your goals include a natural appearance, increased breast size and more
cleavage, a moderate plus silicone implant would be a good option.
Unfortunately without more information, it would only be speculation.
important that you consult with your plastic surgeon and discuss these issues.
After being evaluated, an individualized treatment plan can be formulated
specifically for you.
Replace with teardrop silicone
If you are happy with the shape etc of your implants and just need an exchange, why not use the teardrop shaped implants by Sientra. The addition of Sientra on the marhket has added another choice to patients. Call your plastic surgeon to see if these are available to you. I have just started using them on select patients. Good luck,
Dr. Schuster in Boca raton
Natural appearing breast augmentation with cleavage
Unfortunately the most commonly used type of implants (high profile) and the most common type of placement ( submuscular/dual plane) cannot deliver the natural 'tear drop' effect or cleavage that you desire. Leaving the origination of the pectoralis major medially intact in submuscular placement ensures that the implant cannot be medial enough to look natural, and a flat plateau is left centrally. There are also big problems associated with anatomic implants placed in conventional planes( they work well in subfascial carefully designed pockets). This is why I use a very unique methof of breast augmentation that I call 'cold-subfascial augmantation.' the placement of the implants is not 'above the muscle' or subglandular, nor is it submuscular or dual plane. A very strong layer of connective tissue is meticulously and atraumatically dissected from the pectoralis major muscle and this tissue is used to shape and support a lower profile implant into a gentle tear drop shape. It is the surgical dissection and not the implant itself that gives shape to the breasts. The results sit like natural breasts and do not move like submuscular implants do with arm motion. The fascia also supports the implant giving it relative protection from gravity and aging.
All the best,
Rian A. Maercks M.D.
It is very important to communicate your size goals with your surgeon. 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 “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
I hope this helps.
Replacing tear drop implants
I think your best choice would be a round smooth high profile implant similar to a Mentor Moderate Plus size implant. If your chest is narrow... a narrower base implant will help. If you have a wide chest you will need an implant that has width to it... otherwise you will end up with" funny" looking breasts that are set too far apart from each other.
Good Luck to you.
Kimberly Henry M.D.
San Francisco, CA