Larger implants cause more distortion of the tissues over time
First of all, I would agree with the other physicians who have recommended that you wait at least 6 months before making any long term assessments and certainly before taking any action. By then, your breasts should be well healed and the tissues more at equilibrium.
You have already undergone 2 breast surgeries with relatively large implants (500 cc). Over time, the weight of large implants can stretch out the skin envelope and thin what remaining breast tissue you have.
It is tempting for both the patient and the surgeon to try to "fill up" this excess skin with a larger implant. This may work for the short term, but over time, gravity and the weight of the imlant will lead to an unnatural appearance. I caution you against going any larger.
In addition, cleavage is not a function of implant size, but is more dictated by your chest wall anatomy. If you have a wide sternum (breast bone), your pectoralis muscle insertions are widely spaced, making pronounced cleavage a difficult, if not impossible goal to achieve with submuscular breast augmentation.
You are only one week out from your surgery. Give it time!
Determining the size and shape of implants is difficult and demands considerable attention by you and your plastic surgeon. You are only one week out from your surgery and it is much too early to become upset with the results. Give is time to allow any swelling and bruising to subside, etc.
With respect to obtaining tight cleavage, this is more difficult to accomplish as the implants are in positioned in the sub-muscular plane. The origin of the pectoralis major muscle comes off the ribs near the midline of the chest must be preserved. This restricts the degree of cleavage. Don't assume that bigger is always better! Implants that are too large may upset the natural beauty and balance of your figure. The appropriate choice implant size and shape is complex; it is based on YOUR physical dimensions and proportions and those of the implant. I can speak from 23 years of experience that you need to consider factors beyond just your appearance, focusing on physical activities, lifestyle, hobbies, and vocation.
We are handicapped as we do not know your how big or small you are. Your treating plastic surgeon knows you the best…knows your anatomy…and, knows the operation he performed on you. I would strongly advise you to continue your follow-up care with your plastic surgeon and discuss your issues with him/her. I am sure that with time your results will continue to improve. If not, then the two of you will need to come to some agreement with revising your surgery and utilizing larger implants.
It is too soon after your most recent breast surgery to completely assess the outcome....although lack of fullness in the upper pole, if this was indeed you goal, will not improve over time. A water displacement technique can be used in the operating room to assess implant volume, but I also aspirate the saline from an implant to quantitate the volume "on the table". This helps figure out what size you were and what size I need to add.
Keep close contact with your Board Certified Plastic Surgeon and ask him/her these same questions.
Changing size after Breast Augmentation
At 1 week out from surgery, it is too early to judge your re-augmentation. It is possible to get an idea of volume from previous implants simply by displacing them in water after removing them. Using sizers and having multiple implants available, an appropriate replacement can be chosen. A common concern from patients is not having enough cleavage. When placed in the appropriate position, the implants simply enhance your natural breasts. Trying to create cleavage with surgery often leads to symmastia or an artificial communication between the two breast pockets. This complication happens more frequently with larger implants (>400cc) and is difficult to correct afterwards. Cleavage should be created with a bra, not a knife. I would caution you against going much larger than 500cc. Very large implants do not age well and can cause significant stretching of the breasts over time.
At this point after your surgery, it is way too soon to decide to proceed with another breast surgery. However, revisionary surgery is an option. I would recommend consulting with a board certified plastic surgeon to discuss the best possible and safest option for you. It is important that you communicate with your plastic surgeon and explain to them the look or results you want to achieve. I suggest also waiting atleast 3-6 months before you undergo another surgery.
Unforunately, it is far more difficult to revise the work already done, however, improvements can be made and you must be willing to have realistic results. For more information regarding revisionary breast surgery, check out my website and compare before and after photos of patients. Good Luck!
Revision breast augmentation may improve cleavage.
1) It's almost impossible to advise you without examinig you. 500 cc breast implants are very big and I certainly would not go larger. Huge implants age very badly.
2) You probably need different sized implants in each breast.. I think shape and cleavage can be improved during revision breast augmentation by redesigning the implant pockets.
Breast implants and exchange
I am sorry that you are unhappy with your results. To get more cleavage you may need to have larger implants. Without examining you it would be difficult to say.
Wait a few months at least before assessing where you stand
At a week following a redo, you are jumping into more surgery way too early. Give it time. You might benefit from more surgery but wait at least 3-6 months to let things mature so you can make a decision with which you should be happy. Once things mature you might decide to leave things as they are.
Do not do anything for at least 6 months
Revision breast surgery can be tricky. It can be challenging to perform a revision based on the size of your previous implants, your anatomy and how much your skin may have stretched from your previous augmentation. My initial suggestion would be to wait for at least 6 months to allow your swelling to completely subside and your implants to assume their final position.
It may be difficult to obtain cleavage if your implants are not large enough to completely fill your existing breast pocket. Another limitation my be your anatomy, which may limit the amount of cleavage you will be able to have whether you have implants or not.
My recommendation would be to address these concerns with your surgeon after 6 months if you are still not happy with your appearance.
Breast implant volume is only part of the answer
It is nearly impossible to answer your question without examing you. The dimensions of your implant relative to your chest anatomy is more important that the volume. 500cc is quite large already and you have to be careful about long term effects of having implants that are large relative to your natrual anatomy. Cleavage is a function of natural breast superimposed on implants of a certain dimension and is more easily attain whenthe implants are placed over the muscle.
Have your surgeon go over the options carefully with you. To his credit, it is often hard to know what implant to substitute for implants that are explanted if one doesn't know the size and dimensions of the old breast nor the original size and dimension of your natural breasts.