Doctors help please - Botched boob job

 I'm 5'4' 115# 37yo slightly concave chest given 500cc gummys subpectoral and I came out smaller than I was going in. My ps said he didn't have large enough implants during the procedure. I have a small frame with a natural D cup and went in looking to keep them perky and much to my dismay, came out about a size smaller with lack skin and stretch marks above my breasts that wasn't there before.  To top this off, the cleavage area is giving an offodor and it is not coming from the infra-mammary incisions. Has anyone ever heard of this? Photos I've seen show women going from a B to a D using a 350cc or so and come out looking bigger than me.  How is this possible? Did my ps cut too deep into my chest? I have been given the option for a complimentary redo using 700cc or and my ps recommended to wait for the new contoured 410's from allergan to be FDA approved. But the contoured will require further cutting into my upper chest which I really don't like the idea of. Is it worth it to wait for 410 FDA approval? The before and after shots from dr teitelbaum clinical trials are not that compelling. Now all i want is get my full D back but I am not sure which implant will best achieve that - high profile/mod profile, contoured/round etc. while keeping the perk. Please help...

Doctor Answers 15

Breast Augmentation and Reduction in Breast Size

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     The breast augmentation should have increased your size by 2 cups.  If you post pictures, I may be able to give you an explanation.

Smaller after an augmentation?

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I'm sorry to hear of your anguish and disappointment.  Without photos, no one can really address your concerns.  Regardless, the part that doesn't make any sense at all is it is physically impossible to have a smaller breast volume following an augmentation.  If you are still communicating with your surgeon and have confidence in him, its suggested you bring your concerns to his attention and give him a chance to address your concerns.  If not, seek a second opinion and be prepared to show him/her your before photos at your consultation.  It may also benefit you to better understand where you and your surgeon diverged on your expectations.

Unsatisfactory results in breast augmentation

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Obviously you are not satisfied with the results of your breasr surgery. Without reviewing your before and after photograhs,understanding your expectations, considering your anatomical restrictions and most importantly knowing the details of your communication with your plasic surgeon, it is hard to come up with a helpful recommendation to improve the results of your breast surgery.   

Unsatisfactory Breast Augmentation Result

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For any comments to be helpful, it would be critical for you to post before and after photographs. How it is possible to be smaller after having received 500cc implants is hard to fathom. My suspicion is that the breast tissue is in a lower position than the implants and you were looking to fill that out...which is perhaps the origin of looking for shaped implants now that are larger than 500cc. However, I would make a constructive comment when you post before and after photographs. I would avoid the use of the term 'botched', that is an inflammatory comment and does really induce other plastic surgeons to provide helpful commentary. You may not have gotten the result you want but that in no way implies that the surgery was done improperly. Despite the best experienced from any plastic surgeon, the selection of breast implants is not an exact science and the result is highly influenced by the patient's presurgical breast volume and shape.

"Botched" surgery?--Maybe. Botched description . . . well, let's see.

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Wow! Using that word "botched" is such a pot-stirrer!  (I just wanted you to see how it feels when you're on the receiving end of such an inflammatory word; I really wasn't trying to be unkind or rude.)

Though your description has some glaring inaccuracies/exaggerations/lack of surgical knowlege, as caring plastic surgeons we would never describe your obvious dissatisfaction as "your fault," or you as "ignorant," or your problems (even if ones of perception rather than objective fact) worthy of derisive comments rather than compassionate understanding.

But, to start with, unless you had previous implants and had them replaced (and possibly some scar tissue removed), breast augmentation involves NO tissue removal, only 500cc implants ADDED. But you described your surgery as a "boob job" (a description plastic surgeons do not use), so it is unclear if you had mastopexy (breast lift) plus implants, or augmentation alone (just implants).

Even so, with a breast lift, most surgeons remove no more than an ounce or so of skin from each breast (about 30grams). I have heard some surgeons on RealSelf describe breast lift surgeries where they routinely remove 1/2 - 1 cup size of tissue, which would correspond to as much as 100-250cc (same as 100-250grams) per breast. Perhaps that is what your surgeon did if s/he uses this type of tissue-removal breast lift technique. (BTW, this amount of tissue removal is NOT necessary in order to perform a beautiful lift that preserves all but 25-50grams of skin per side!)

Thus, adding 500cc per side, even with removal of skin to perform a lift, or removal of more tissue to perform the type of "lift" (actually a cosmetic reduction) described above, is physically incapable of making you smaller! Perhaps not "big enough," but absolutely not "smaller than I was going in."

You also said you had 500cc "gummys" used. Were these the style 410? Obviously not, since you asked about them later. But if you had smooth (or textured) round implants by ANY manufacturer these are cohesive gel implants, NOT "gummys," which is a term commonly used to describe even-more-cohesive style 410 textured shaped investigational implants made by Allergan.

If indeed you wore a D-cup bra at 5'4" and 115#, even with a pectus excavatum, adding 500cc implants per side should have added between 1 1/2 and 2 cup sizes to what you started with (unless, of course, you had previous implants and/or tissue removed that exceeded 500grams per side).

I can only imagine without photographs or examination what things looked like before and after your surgery, but I don't think I have ever seen breast augmentation CAUSE stretch marks (augmentation can cause existing ones to change color and become more visible), and I know adding implants will not make skin more lax, only filled to some degree. I have only seen a few women with "natural D-cup" breasts that could be described as "perky," but adding 500cc (just over a pound) per breast not only "fills" your skin brassiere substantially fuller, but also adds extra weight that can be expected to stretch and sag breast skin over time, since gravity never sleeps!

I am at a loss to explain your cleavage odor. If your surgeon is allowing you to shower, a good antibacterial soap should be all that is required to deal with this. If you have breast lift incisions, follow your surgeon's bathing/showering instructions.

In creating a pocket for breast implants (augmentation only, no breast lift), your surgeon cuts through tissues but does not remove tissue, and a pocket is created by lifting the pectoralis major muscle, not removing part of it or part of your ribcage. You should still have everything you started out with (tissue-wise, unless skin removal was done for a lift, as described above), PLUS your 500cc implants.

If you want to be bigger (and your tissues accommodate this request anatomically), then going to ANY larger implants--700cc or any other--does not require removal of tissue, only enlargement of your pocket. If you and your surgeon really want to use shaped cohesive implants (like the style 410 "gummy bear" implants that are not yet FDA-approved), Sientra makes FDA-approved shaped implants in numerous sizes and shapes.

For primary augmentation, as well as virtually all secondary implant enlargements, I still prefer the smooth round cohesive silicone gel implants by any of the three US implant manufacturers (Mentor, Allergan, and Sientra). Size and profile depend on your wishes and anatomy.

As others have stated, in-person examination is still the best way to get accurate and helpful information, especially as any on-line consultant, no matter how well-trained, experienced, and skilled, has no way to accurately assess your situation without seeing how things were before surgery, and how they are now. Please submit photographs here, or see one or more ABPS-certified plastic surgeons for additional opinions. When you do, don't be too negative or harsh about your initial surgeon; your next surgeon doesn't want to be described that way to surgeon number three! Best wishes! Dr. Tholen

Frustration with Breast Augmentation Result

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It is difficult to understand how adding volume to your breasts would leave you smaller than your pre-operative appearance.  Decreasing the size/volume of your implants will likely leave you more frustrated with your result regardless of what shape/firmness your implants are.  As others have mentioned, photos will help with further recommendations and ongoing conversations with your PS will be invaluable.  Best to you.

Post operative dissatisfaction with breast augmentation.

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I agree with the other physicians in that it is difficult to give you advice without an exam or at least, photos. If you are willing, please post photos so we can be more helpful in your concerns.  

I also think being smaller after placing 500 cc implants is highly unusual. For all of our education and to help you, please consider posting before and after photos. I would also encourage you to keep in communication with your surgeon.




Disappointment after breast augmentation

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Since there are no photos, it's difficult to comment on your results. It's also unclear if you had additional procedures such as breast lift or reduction at the same time. Chest wall deformity definitely can affect how your breasts look after implant since the implant is sitting right in front of the chest wall. As far as implant selection is concerned, only a actual in-person consultation will help decide which type of implant is most suited for you.

Best Wishes,

Breast implant issues

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Without an exam and seeing before photos as well, there really is no way to comment on your results. It would be almost impossible not to see a larger breast with 500 cc implants unless tissue was removed?

Problems with a breast augmentation result

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It is certainly difficult to explain your situation.   If 500 cc implants were placed there is no physical way that you could actually be smaller.  If you are early in teh post operative  period it may be that the muscle is pushing the implant laterally and this combined with your chest concavity may be part of the problem.  A photograph of your before and after results may be helpful.  

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.