Wide set breasts with small implants, would a larger implant improve the appearance? (Photo)

Question

Hello, I had breast augmentation about a year ago and got 250cc moderate plus saline implants. I believe all my swelling has gone down and I'm not completely happy with my result. I feel as though my breasts appear very small and since they are wide set I don't have the cleavage that I would like. I liked the look of the implants better when they were still a little swollen. Would a larger implant or different profile improve the look or just give me too much side boob?

Shlomo Widder, MD · Answer

Dear hf,   Thanks for submitting your before and after pictures as well as your goal picture.Sorry for your unhappiness with the outcome of your breasts augmentation surgery.   From observing your pictures, you appear to be small A cup before surgery and asymmetrical small C cup size after surgery. Your cleavage is very wide and the implants are displaced laterally, beyond the anterior axillary line .     The pictures of your breasts right after surgery appears to be full C cup size . You did not provide your chest circumference in inches , which is critical for the correct implants size selection. Let's assume that you were before surgery 32 small A cup size, to become 32 full C you would have needed implants with volume of 375 cc. For 34 full C cup - 450 cc.   In regard to the creation of nice cleavage, you will need medial capsulotomy (scat release) and lateral capsulorrhaphy (internal bra). The best approach to doing ot is through a sub areola incision, which allows for easy performance of the necessary maneuvers under direct vision and feel. The sub mammary fold incision is too far for that.   You have to realize that not all results are the same, because experience, skills and aesthetic eye are critical for good outcome. So do your due diligence carefully and choose your surgeon wisely.   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 in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                                  Best of luck,                                                            Dr Widder

Jed H. Horowitz, MD, FACS · Answer

The profile is determined by the amount of projection versus roundness that the you desire, as well as the size of the implant and size of your chest. As much as it's important to know what size bra you currently wear, the strap size is important to know as well. It affects the diameter of the cup and subsequently the diameter of the #breast implant that you choose.If you choose to go larger to accommodate wider implants which may occupy more of your chest,  Breast #Lift to support the added weight of the implants, may be required. A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is the most suitable for #breasts which sag or droop (ptosis) as a result of development, aging, pregnancy, breast-feeding and weight loss . Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy. Altogether, the surgery will create an elevated, more youthful breast contour. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring. The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

Janet Woodyard, MD · Answer

Surgery would be required to replace your current implants with ones with a wider base diameter to decrease the space between the breasts. This requires opening and enlarging the capsule in this area. I always recommend the use of a bandeau to hold the implants in while healing and long term during exercise because subpectoral implants have a tendancy to migrate outward over time. Best wishes.

Steven Wallach, MD · Answer

Cleavage in many ways is determined by your anatomy.  Wider implants may cheat it in  a bit................

Tom J. Pousti, MD · Answer

Yes, based on your description of goals, the use of larger breast implants (plus capsulorraphy,  if your breast implants drift to the sides and/or are too low), will likely be helpful when it comes to achieving an outcome that you will be happier with.

Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “ improve the appearance” or "up a cup size” or "D or DD cup" etc 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.

3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.
I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps. Best wishes.

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