Breast Implant Revision Surgery - How to Explain to Doctor What I Want?

I had a breast lift with saline implants on 5/25/10. I specifically wanted my fuller breast with my nipples more in the center of my breast and more fullness on top. I didn't come out of surgery with the look I expected. I was 38DD and only had R250/270cc and L225/240cc and am still a 36-38DD. Now having redo because of no fullness Doc says I have to go with a larger round implant not a higher profile. How do I make him understand what I want and I don't want to be huge just full w/ cleavage.

Doctor Answers 10

Revisionary breast surgery

Based  on your pictures it seems  that you would benefit from bilateral inferior capsulorrhaphy (use of permanent internal sutures to correct inferior  displacement of the breast implants).

If revisionary surgery is decided upon, it will be 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.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Revision Needed

Consult with your Board Certified Plastic Surgeon to discuss your concerns. Perhaps you can view photos together in order to make certain you are providing a 'visual" of what it is you are looking to achieve. You definitely need to have a revision. best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon
4.6 out of 5 stars 33 reviews

Larger implants will worsen bottoming out

Bottoming out is a condition where the breast implants drop, increasing the amount of breast between the bottom fold and the nipple as compared to the upper half. The photo here shows a fairly dramatic example. Larger implants will add more weight and make it worse over time not better. I do agree with new implants but smaller, with careful attention to matching the base diameter, and possibly adding a Strattice graft as an internal bra for more support.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Say No to bigger implants

Evaluation of your photo demonstrates a very common occurrence.... bottoming out. Your photo shows that your nipples are "star gazing" and that the lower pole (from nipple to fold under breast) is very long.  These issues can easily be corrected by revision of your previous surgery to remove some of the lower pole skin as well as placing Strattice or Alloderm (I prefer Strattice) in the breast to provide better lower pole support and decrease the likelihood of this recurring.

Delio Ortegon, MD
San Antonio Plastic Surgeon
4.1 out of 5 stars 25 reviews

Larger implants are not the solution

Larger implants are not the solution and generally speaking are more likely to make your condition worse. I would recommend a procedure to correct the bottoming out of the breasts and consider conversion to a horizontal scar.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Breast Implant Revision and Bottoming Out

I would not recommend going larger with the breast implants. You have bottoming out of both of your implants. This makes your nipples look too high and flattens the upper pole of your breast. The first instinct is to go to a larger implant. But this can lead to more problems. One reason you may have bottomed out is because your tissues could not support the current implants you have. And although there are other causes of bottoming out, if skin elasticity is the reason, then going to larger implants will just cause your breasts to bottom out again.

What needs to be done is to revise the breast lift and shorten the distance between the nipple and the breast fold. By doing this the breast implants will be displaced upwards which will correct both the high appearing nipples and the flatness in the upper breasts.

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 45 reviews

Reduce the nipple to fold distance

You certainly dont need larger implants.  The distance from your nipple to the fold needs to be reduced and the volume of your implants displaced upward for increased fullness.  I suggest that you also consider changing to a textured silicone gel implant and a neosubpectoral pocket.  

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 145 reviews

Breast revision

Breast revision I think is the way to go for you. It looks like yoiu have bottoming out and alot of excess skin below.  You should discuss your concerns with your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Communicating with your plastic surgeon

Unfortunately you discovered only after your surgery the importance of proper communication with your surgeon. It is paramount for the surgeon to understand patients' expectations prior to surgery, and advise the patient properly as to the realities of their expectations. In our practice we use photos of prior patients' results to help us communicate with pre-surgical patients. In your case, you could have shown your surgeon the type of breast you envisioned for yourself. You seem to have done a good job describing what you want in your question.

It seems to me that you could have benefited from a sub-muscular placement of an implant, and a type of a lift that would remove all the redundant tissue in the lower pole of your breast. In my experience this eliminates the bottoming out effect that you exhibit in your photo.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.7 out of 5 stars 56 reviews

Breast implant and lift revisions, how to get what you want

Please post a photo, as it is nearly impossible to give good opinions without them in a case like yours.

DD breasts are inherently full and large, if not shaped how you want them.  I would likely not have recommended implants for you at all, given your starting bra size.  A good breast lift should get you a better shape without using implants. 

Larger implants will only make you larger--they will not give you prolonged upper pole fullnesss.  You SKIN quality and the weight of your breasts (plus implants) dictates your breast shape over time.  It is completely natural to have some flattening of the upper breast over time, as skin settles.  If you have a large implant,, this will happen sooner than if you don't have an implant.  With breasts, truly, the bigger they are, the harder they fall.

Post photos, and I'll be happy to amend my current opinion as needed.  Best wishes!

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 42 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.