Will a smaller implant size give me a nicer/natural sag?

Question

Hey! I had a breast augmentation 2 years ago. I was originally an A sized cup however am now a D. My doctor gave me 440cc implants however, I believe they’re too big for my body as they are too stiff looking and look as though they’re just stuck there. I was wondering if I got a smaller implant size as well as a lower profile if I would get that more natural sag effect rather than them just sitting there? I also have a slight double bubble on my left breast.- 20yr Female, 168cm tall & 63kg.

Randal Haworth, MD, FACS · Answer

You may have developed a capsular contracture.

This is a condition that arises when the scar tissue capsule that forms around the implant hardens. While the scarring in most cases remains thin and supple, some individuals may develop capsular contracture where the capsule hardens excessively and presses the implant, leading to an abnormal appearance. The symptoms of capsular contracture can vary from subtle to severe, depending on the severity of the condition.

Treatment options for breast implant capsular contracture may involve:

-A breast capsulectomy, which involves removing the breast capsule
-Replacing the current breast implants with a 5th generation breast implant
-Changing the implant pocket to a sub-pectoral plane
-Replacing the implant shell with a textured breast implant
-The effectiveness of ultrasound energy and medications (such as steroids and Singular) in treating capsular contracture is a topic of debate.

Moreover, taking preventative measures during the initial implant surgery, such as utilizing anti-biotic irrigation and creating a bloodless implant pocket, can reduce the likelihood of developing capsular contracture. Additionally, placing the breast implant under the muscle can also help decrease the incidence of capsular contracture.

Sean T. Lille, MD · Answer

You didn't mention what type of implant you received, but typically a smaller silicone implant will look more natural.

Daniel Barrett, MD · Answer

Dear april20022,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

You did not post photos, but with the double bubble, I do recommend going down in size, perhaps 300-350 cc's for a more natural look.

Will a smaller implant size give me a nicer/natural sag?

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