Right Implant Sits Significantly Higher, How Many cc's Do You Recommend For My Revision? (photo)

My first breast augmentation was on 10/31/11. Submuscular, saline implants, 380cc, aerolar incision. My right implant sits significantly higher. When I recieve my revision I would like to go one cup size up. How many cc's would you recommend to achieve my goal? Should I switch from saline to silicone to prevent this again? Is it a good idea to a revision and up size at once or should I do two seperate surgerys? Also my nipple is naturally off center is there anything that can be done about this?

Doctor Answers 9

Breast Augmentation revision

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You have many different things that are "wrong" with your breasts. Obviously, there is malposition of the right implant but the left is also off center of the nipple. I would also like to know how and when the right implant got to its current position. It would be very helpful to see your original before pictures also.

At any rate, you and your plastic surgeon need to sit down and try to decide each of the problems, why they happened and what can be done to fix them. Regarding size, you should try sizers on in the office and also bring in pictures of what you would like to look like.

Before you proceed with revisional surgery make sure you have answers to all your questions.

Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Implant Malposition, what is the best way to fix it?

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Great question and pics for everyone to see, thank you. I do believe that results can be acheived in one operation, but it appears that you may have a capsulr contraction going on on the right, or hardeneing of the scar tissue on the right side? Changing the size or material of the implant will not neccesarily fix the issue but it may help. It is important to discuss with your surgeon what he believes caused the malposition issue and what he plans to do to correct it, unfortunately these issues do occur even to the best surgeon, there is no real good solution to center your nipple, I would say tolerate it at this point, maybe in the future you may have enough skin laxity to fix the issue. Good luck!

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Breast Augmentation Revisionary Surgery Options?

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Thank you for the question and pictures.

I think you will be able to achieve the results you are looking for safely in a one stage operation. In  other words, the breast implant symmetry  and size of breast implants can be changed during the same operation. Exchanging from saving to silicone breast implants will not necessarily prevent recurrent implant malposition problems.

In regards to breast implant size, it  will be very important to communicate 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 “Increase one cup size”   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 breast 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. 


If your nipple/areola complexes are off centered ( points to the sides),  this may be because the breast implants have been positioned too close to the midline ( in attempt to achieve "better cleavage" for you.  Centering the nipple/areola complexes may involve  correction of the breast implant pockets (capsulorraphy to close off the space close to the cleavage area  and opening the breast implant pocket  on the sides of the breasts).  This maneuver will improve the positioning of the nipple/areola on the breast mounds but will also increase the space between the breasts in the cleavage area.

I hope this helps.

Right Implant Sits Significantly Higher, How Many cc's Do You Recommend For My Revision?

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You have a problem with asymmetry ,and  the submuscular implant position possibly causing a high riding implant on the right

Asyou currently have saline implants ,you may want to consider adjustable  saline implants

This would give you the ability not only to change the size after surgery, but also to modify the shape

I would also consider conversion to subfascial placement

unfortunately Adjustable gel implants are only available outside the USA ,this would be an excellent choice for you 

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Breast Augmentation Revision

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In my opinion, you will benefit from a revision procedure. I recommend patients wait six months before any type of revision and you're now at that point. Obviously, before pictures would be very helpful. Regardless, I do believe you can have better placement. 

Breast revision

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It is certainly possible to increase the volume of the implant and adjust the pockets, etc..  As for implant chioce saline vs silicone, it is really up to you.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Implant revision

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There are several problems here, as already noted.  Asymmetry, the variation in implant heights, capsular contracture and implants that are too wide for your chest.  Larger implants will only worsen the last problem.  I would focus instead on correction of the capsular contracture and creating symmetrical breast pockets.  Switching from saline to silicone may be beneficial.

Consideration in impant revision

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There seems to be some degree of capsular contracture on your right.  Additionally,the implants are too wide. They should be centered beneath the nipple.  I would have a thorough discussion with your surgeon prior to any revision.

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 9 reviews

The correction of the asymmetery should be the primary goal

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The size of your breast implants are too big for your breast tissue and going larger will make the revision harder. Your left implant pocket is too medial and that causing your nipple to point side way. The position of the implant should be corrected over the right side.This can be secondary to the capsular contracture or incomplete muscle release. Please do not push your surgeon to go bigger. He or she will agree to it to make you happy ,but will have long term problem with larger implants.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 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.