The right size for you
It is very difficult to determine the best implant you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants.
Thank you for your question. With time, the implants drop into their final position. Wait 3-6 months before getting a better idea about your final appearance. Be sure to discuss your concerns with your plastic surgeon. Good luck.
Implant not dropping
Generally speaking, especially early in the post-operative
phase of healing, it is not uncommon to have one or both implants appear to be
high up by the clavicle. Although the “pocket” may be made correctly, the
implant may not have access to the bottom for several reasons. If the overlying
muscle or skin is tight, this will move the implant to the path of least
resistance which is up and towards the underarm where there is little or no
pressure. As the pressure relaxes, the implant will drop down to the bottom.
Smooth implants, because their surface is slippery, may move faster downward
than a textured implant with its rough surface. Because these variables
mentioned above can be different for each side, it's not uncommon that one side
will drop faster to the bottom of the pocket than the other. Similarly,
sometimes one breast will swell more than the other or be more painful than the
other early in the postoperative phase. After the first month or two, usually
things will even out. It wouldn't be, in my practice, until four months or so
has passed that I would entertain going back to the operating room to “touch
up” the location of the breast implant in the pocket. Sometimes specialized
bras or straps as well as massage and stretching protocols may be helpful in
allowing this process to happen more quickly. Each plastic surgeon will have
different thoughts on what the best protocol is for the patient. Your operating
plastic surgeon will be your best resource to have this information passed on
to you. I recommend that you faithfully follow up and follow the instructions
of your chosen plastic surgeon. Congratulations on your surgery, and good luck
on an uneventful recovery.
The evaluation will require at least a photograph to help determine bottoming out of the implant. Aggressive open capsulectomy of the fold can lead to bottoming out or dehiscence.
Most likely normal
It is not unusual for your implants to settle at a different rate after breast augmentation or revision breast surgery. I would wait 3-6 months and see where they settle. They should settle in a predictable position based on your anatomy.
Nana Mizuguchi, MD