I Currently Have 500cc Implants Possibly Bottoming Out- Steps and Cost To Revise Again? (photo)

I originally had augmentation in 2005 with saline 275cc implants taking me from an A cup to a B cup. I had a revision in 2008 with 500cc silicone implants as I didn't enjoy the ripples I had with Saline. I nursed a baby for 15 months shortly after getting my implants in 2008. I think I am bottoming out on my left and would like my nipples to once again be even as well as I would like to replace my 500s with 650-750cc silicone implants. What steps would be necessary and cost?

Doctor Answers 6

Should I get larger implants ?

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Your breasts look really nice, and proportionate with your body.  The implants are symmetric, although the nipple-areola complexes are not (as they were not before your first augmentation).  You're not "bottoming out" on the left.  If you really want larger, fine, go ahead, but be forewarned that over time, heavier implants will stretch your skin envelope more, gravitationally descend, and eventually mandate formal mastopexy (breast lift) and associated scars, which will likely be your fourth procedure. 

San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Costs to Revise Implants From Bottoming Out

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The #costs of a breast #revision are contingent on several factors. Such as geographic location, the skill and experience of the surgeon, and operating room and anesthesia fees. Also, different breast implants may have different costs. The approximate costs can be found here on the Real Self website, Surgery.org, or PlasticSurgery.org.

Moreover, your procedures should be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. I suggest you view before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Revision Breast Augmentation

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Hello 3xcharm,

I am going to be perfectly frank with you regarding what Drs. Wallach and Johnson are alluding to.  Your plan is poorly thought out (not your fault, you were probably never given the proper information to begin with), and puts you at risk for not only recurrent malposition of the implants and the nipple, but also recurrent rippling too.

One can't simply pick out an implant size based solely on aesthetics, like picking out a pair of shoes.  This thinking is the root cause of most complications that lead to early and unexpected reoperations, and is usually associated with inappropriate implant size or profile.  There needs to be an overhaul of the whole process of breast augmentation, towards an objectively defined process that can be measured and real data obtained. It really is not about what size or shape you think you want, its about the right implant size for your anatomy.

Larger implants will further expand your tissue envelope and most likely lead to rippling, regardless of silicone gel implants - they ripple too.  Your tissues have already shown a propensity for unpredictable stretch leading to drop out of one of your implants, malpostion of your implant, and malposition of your nipples.  What makes you think replacing those with implants 50% bigger will not have that same effect?

I can tell by your tag name that you are expect this to be your last operation.  Unfortunately, if you stick to your current plan you will probably be wrong.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews


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Remember if the breasts are sagging a bit and you put a heavier object inside, they may sag some more.  All you may need is a small lift or circumareola on the left one in the picture.( or your rigth side of your body)   An exam is critical.

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

Steps for breast revision

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When considering breast augmentation it is important to be certain about the size and what effect the larger implant will have on you tissue. The second step is to consider whether a lift may be needed if asymmetry issues present. Based on your photo we don't see that the implant has bottomed, and the skin envelope will accomodate the fuller implant. The lower nipple may need a lift as the implant is unlikely to correct the nipple without.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast Augmentation Revision "Steps"

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 Thank you for the question and pictures.

I think your plan is reasonable. The first step with be arranging consultation with well experienced board-certified plastic surgeons. Hopefully, by adjusting the breast implant capsules your symmetry can be improved upon. Hopefully, unilateral breast lifting will not be necessary.

In planning your breast augmentation revision procedure it will be very important to communicate your size goals with your surgeon.  in my practice I find the use of goal pictures to be very helpful.  I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" 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.

I hope this helps. 

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.