2nd stage breast augmentation result ideas? (Photo)

Question

I had a breast enlargement with 525cc high profile round implants, they were in for 7 years and were far too big for my frame. I chose to have them removed in a 2 stage in the hope I did not need a lift as didn’t want the additional scarring. 1.5 years later,Ideally I would like a small anatomical implant to create more fullness in the skin and a little better shape… but not increase size too much as I like them small. I want to be advised on whether this is feasible without looking to saggy?

Daniel Barrett, MD · Answer

Dear Persistent7899,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Elisa A. Burgess, MD · Answer

Revision surgery can be a little challenging once the skin has been stretched out from a larger implant. So it requires an in person exam to evaluate the quality of the skin with stretch marks and the position of  the nipple relative to the fold. I also evaluate the softness of the capsule around the implant and the position of the implant. Measurements are made and an exam is done to evaluate for breast masses. I listen to the patient regarding the size reduction goals and help make some recommendations. I think a meaningful size reduction needs to be at least 50 to 100 cc smaller. Sometimes inner pocket adjustments and mastopexy needs to be done at the time of implant exchange. Make sure to see a board certified surgeon with experience.

Gerald Minniti, MD, FACS · Answer

First, you didn't need to take out your implants if they were too big. It would have saved you this scenario if a competent surgeon put in smaller implants. Second, shaped implants do not yield a better or more natural results than round implants. In fact based on the selection of a given implant from either category, one can end up with round implants that are very natural in appearance, and shaped implants that look fake. Stick to round and smooth under the pec major muscle for your best chance of a good long term result.

Gary M. Horndeski, MD · Answer

Your breasts are widely separated, they are low on the chest wall and you have poor cleavage. Augmentation alone will not solve your problem. Many women do not like lifts because of the vertical scars associated with traditional techniques. There is an alternative technique called The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

Yes, you can have small implants. I would suggest meeting with your surgeon and try on a range of sizes to see what you like.

Hilton Becker, MD · Answer

You may be a good candidate for fat grafting to your breasts 
It appears that you do have some extra fat on your abdomen and flanks.

Richard P. Rand, MD, FACS (retired) · Answer

First, you need an implant which has a proper base diameter to match yours or you will be left with a gap in the middle. Next, use a smooth wall low profile style round as these look the same as "anatomicals" without the extra issues of implant texture. Last, you could do a periareolar lift on the lower side to get the nipples leveled out. No "full" lift is needed for you.

2nd stage breast augmentation result ideas? (Photo)

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