I Ended Up with the Wrong Size and Implant.

Question

On April 7th I got my breast implant surgery. I let my doctor picked the size of my implants but we agreed in using a HIGH PROFILE. Instead he used a moderate plus (without consulting me) which is not giving me fullness, projection, or cleavage. I am very unhappy with the results I am a 5'2 120lbs and I feel the same or even worse before the surgery. These implants did not do anything for me I was a very saggy small A and he used 375cc with silicone moderate plus to give me a B cup.

Gerald Minniti, MD, FACS · Answer

Hello Lasky,

	Your doctor did you a favor.  Your complaints of feeling worse now seem unwarranted (assuming he performed the surgery well).  Being an A cup and getting  375 cc implants is hardly a small change.  Your desire for a particular bra size and implant profile is really not your choice.

	The most common mistake plastic surgeons make in breast augmentation is utilizing implants that are too large for the patient's anatomy.  This is a costly mistake for the patient, usually forcing an unexpected reoperation.   These reoperations can be difficult to perform in order to correct those problems associated with large implants.

	The buzzwords in plastic surgery is 'patient safety'.  More than any other time in cosmetic surgery, we are starting to get and utilize data to help guide us in performing better surgery.  300,000 women get implants every year and somewhere between 15 to 30% (national average) of them will have reoperations within two years.  That is an unacceptably high number.  The American Society of Plastic Surgeons and The American Society for Aesthetic Plastic Surgery are in the midst of a national campaign to educate patients about safe plastic surgery.  Similarly, there is an internal campaign to educate surgeons about specific procedures and how to best perform them.

	You are less than two months from your surgery and thing are still in flux. You should relax and allow your body to fully heal; go back to your surgeon to take after photos at three to four months.  Then take a look at the results.  Hopefully you will appreciate it!

	Best of luck!

Camille Cash, MD · Answer

Implant selection involves a detailed conversation with your surgeon about what you want, and don't want, from breast augmentation surgery.  You are still in the healing phase from your surgery, so you may still see some changes ahead.  I encourage you to discuss your concerns with your surgeon.  Since you left the ultimate implant decision to your surgeon, it is important that you understand why this particular implant was selected for you.

Tom J. Pousti, MD · Answer

It would behoove you to continue to see your plastic surgery and communicate your concerns in a calm,  non- accusatory fashion.

	If revisionary surgery is decided upon, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" 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 press 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.
	By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.
	I hope this helps.

Hilton Becker, MD · Answer

Implant size isselected based on your base diameter.  .  Your surgeon may have chosen your implant profile based on you base diameter.

Beverly Friedlander, MD · Answer

There are many different factors that go into selecting an implant. There is difference in 8 mm which is less than 1/3 of an inch between a 375 CC high profile implant and a moderate plus profile implant. It is unlikely that you would have achieved the fullness projection or cleavage you are seeking by simply using a different profile 375 CC implant. If you are unhappy with the size, shape or appearance of your breast, you should discuss this with your plastic surgeon and consider a revision using a larger implant or possibly even an uplift, as you said your breasts were sagging before surgery. Good luck

Kamran Khoobehi, MD · Answer

The change from high profile to moderate plus will not cause noticeable difference on the size and shape. You are not happy with result and the blame should not be placed on the implant shape. You need to discuss your concerns with your surgeon. You have trusted him to operate on you and he or she did not change the shape to give you bad result.

Mark B. Constantian, MD, FACS (retired) · Answer

There are many sizes and styles of implants, but at some point you have to trust your surgeon.  A 375 cc implant is relatively large, and should give you nearly a 2 cup size difference.

	Remember also that it takes no more effort for your surgeon to insert a high profile implant than a medium profile implant.  The decision was undoubtedly made for your well-being.  Too large an implant can stretch the skin and breast gland over time to create deformities that are impossible to fix.

	Be glad that he or she was careful.  Wait to heal and then discuss with your surgeon.

George Lefkovits, MD - Account Suspended · Answer

The choice of the style, size type of impant needs to be carefully reviewed prior to surgery. The size and stye chosen depends on yourf chest dimensions, overall height and weight, your desired look and the advice of your plastic surgeon. The ultimate aim is to achieve a natural result which is proportional to your body. Sometimes the patients desired results may not be appropriate and the plastic surgeon has to explain that. I encounter this occasionally and usually the patient accepts my recommendation. There are occasional times when the surgeon may have to change the size or style( high profile to moderate profile) during surgery because the planned size/style is too tight for the skin envelope which can therefore lead to complications. In any case based on your information the difference from a high profile to a mopderate profile should make very little difference in your overall result. But no matter what ytour plastic surgeon is there to make you as happy as possible. You should return to him and voice your concerns and let him explain why he changed the implant style.

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