Implant size for revision?

Question

5’6 200lb 24 year old Woman with broad shoulders .I’m currently about a D cup and hoping to be a triple D. I had a breast reduction back in 2020 and it left me with disproportionately places nipples, saggy breasts, and dog ears. I have a revision/argumentation planned but not sure what size implants to go with. Any insight?

Chet Mays, MD · Answer

Thank you for your inquiry! We would love to see you in person and discuss your options.  Trying on implants to see how they fit your frame is the first step.  Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals!

John LoMonaco, MD, FACS · Answer

Implant size selection is an important process and varies between surgeons.  General rules I like to follow to help ensure patient's satisfaction are:

1) View photos together with your surgeon so he or she can understand what you think looks good.

2) "Try on"  implant sizers with a non-padded bra and fitted top in the presence of a trusted friend or spouse.  I'm not a big fan of the computer simulations

3) Ask your surgeon what they think your tissues can safely hold...oversized implants that stretch and deform the skin and breast tissue are a major cause of dissatisfaction and more surgery.  This issue is even more pronounced in patients who have had prior work done.

Gary M. Horndeski, MD · Answer

If you have had a reduction and now have problems with the shape then you need to provide photographs so we can see what is going on. More important than the augmentation is the reduction revision. If you are a D then you do not need to be bigger but do need to be reshaped. The technique I recommend is 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 can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Farbod Esmailian, MD · Answer

It is really difficult to answer your question as there is a lot that goes into sizing our patients.  We perform measurements, evaluate the skin envelope elasticity, look at photos, look at diagrams and finally use the Allergan sizing system to size the patient in the office.  We obviously listen and discuss exactly what the patient wants and doesn’t want so that we can deliver the expected results.
Your best path to determine what size would work and how big you can be would be to seek out a board certified plastic surgeon to discuss your options.  Make certain the surgeon you choose has great deal of experience in breast implant surgeries.

Hope that helps.

Connie Hiers, MD, FACS · Answer

With the need for a reduction, your skin has been stretched and will not support heavy breasts. Please do not go up to DDD.  You are sagging now, so another lift is needed. I would suggest placing the implants behind the muscle for best upper breast fullness and some support to the additional weight.  some breast tissue could be removed to help accommodate a larger implant.

Camille Cash, MD · Answer

The first step is to schedule a consultation with a board certified plastic surgeon.  During this time measurements will be taken of your breasts.  This is different than bra size.  You will also discuss your desired look with your surgeon.  This will help her/him suggest possible implants for you to consider.  If your breasts are wide you will likely be able to carry a larger implant with a nice result better than someone with a narrow frame.

Mats Hagstrom, MD (license on probation) · Answer

Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Some plastic surgeons do this better than others.
Without having access to pictures, we can’t begin to make an assessment.
I suggest having a few in person consultations with plastic surgeons in your community to see what each one has to say.
 Like I said, different providers do this differently.
Some plastic surgeons will make the final decision during surgery.
Some plastic surgeons will make the decision and only bring one pair of implants.
Some plastic surgeons will have the patients make the final decision.
 my personal preference is to before and after pictures until I have a clear understanding of what the patient is trying to achieve.
I bring images that are good representations of the ideal outcome with me to the operating room.
I Use temporary sizers during surgery to determine what size implant will deliver results consistent with the images the patient has provided.
I typically have a complete set of implants available to meet during surgery.
By making the final decision, I’m ultimately responsible which some providers are apprehensive to do.
When patients make the final decision, the patient is responsible for that decision.
That is in someways and advantage to the provider.
In my opinion, the plastic surgeon is in a better position to make the implant decision based on their years of experience.
It’s very important to have Good communications.
Insist on providers showing you lots and lots of before and after pictures to make sure you’re on the same page and have a good understanding of what your results are likely to look like. Best,
Mats Hagstrom MD

Implant size for revision?

Answers (7)

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