Is replacing my 600cc implants with 500cc moderate plus worth it? (Photos)

Hi dianahubek,

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.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

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, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Dear Diana,   Thanks for posting your pictures, though, it would have been helpful to see the before pictures. Sorry for your unhappiness with your breasts augmentation revision.    From observing your pictures, you appear to be DD cup size with the following asymmetry:left nipple lower and right sub mammary crease higher, which creates the asymmetrical fullness on the upper pole slope.   You did not provide your chest circumference measurement in inches, which is critical for the correct implants size selection. Let's assume that you are currently 34 DD. To become 34 D cup size, which is more natural and comfortable for you, you will need implants with volume of 450 cc or 475 cc. Reducing the size of implants will help to reduce the weird  fullness up top of the right breast   Additionally, in order to improve on the asymmetry that seems to bother you, you will need left breast inferior capsulorrhaphy (internal bra) , to level the creases  and  left mini lift to even up the nipples height.   Discuss these issues with your surgeon. At 3.5 months after surgery, you can redo the breasts augmentation with the above mentioned corrections,  though, if you  wait 2-3 month, it will be beneficial for the capsulorrhaphy, since the capsule will get stronger.        Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                              Best of luck,                                                     Dr Widder

Thank you for your question.
Looking at the photos attached, I agree with you that your implants are a little too big for your chest and your breast footprint diameter. Breast footprint is a term which defines how your breasts sit on your chest wall. It is very important to consider the footprint in implant selection unless an individual patient specifically wishes to have very large breasts. Having implants that are too big for the footprint means that there is very little cleavage (sometimes this is desirable), implants drop more with gravity because they are heavier, heavier breasts can be sore, breast skin stretches and breast tissue thins which can lead to rippling and implant edges being much more visible and, in addition, patients can feel implants laterally between the chest and the arm. 
The other thing is that every time the implant needs to be changed a very slightly bigger implant should be used because the implant pocket of a specific size has been created behind the breast tissue to fit a specific implant. In other words, trying to put a smaller implant in a large breast pocket might make the implant float and flip. However, having said that, it is possible to make adjustments to the pocket i.e. make it smaller or create another pocket but implications of that should be discussed with your surgeon in detail in application to your specific situation addressing your desires and concerns to help you make a balanced informed decision about whether or not it would be worth it for you to have implants changed. 
Also, the more you change breast implants the higher the risk of capsular contracture. You are also asking why your breast looks weird when you are laying down. I think that what you are seeing is the edge of the breast implant. 
Regarding the pain in your breasts, it might settle down because scar maturation process takes about a year and you are only 3.5 months after surgery. 
On the whole, I feel that you have a reasonable result from your surgery particularly looking at the picture in standing position. However, if heavy implants bother you then it might be worth having a chat with your surgeon about whether or not it would be worth going through another surgery. It depends on how these heavy implants bother you really. 
Hope this helps. 

Dear Dianahubek,Hello and thank you for your excellent question. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. The size, profile, shape, texture, and type of implant (e.g., saline, silicone, “gummy bear”) is based on your desired versus existing breast size and shape, your chest wall measurements, and soft tissue quality. It is essential that you have an in-person consultation to develop a treatment plan that specifically addresses your personal surgical goals, and your body’s anatomy. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

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