450-350 with Local or GA and Capsule Work? (photo)

5'5", 120lbs, Mentor silicone HP. My pre op 04/29, surgery 05/06. My new PS said implant swap from 450cc HP silicone to 350cc HP silicone can be done with a Local does no require capsule tightening. What are the drawbacks to this approach? My 450's are too wide for my frame and very uncomfortable. PS said the implant violated the boundary of breast envelope. He said some women love that look, but it is too large for my frame. Also said I can try 325,300. Is that too far without capsule work?

Doctor Answers 5

Correcting implant malposition

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From the information that you have given you are correct.  If your implants are drifting off laterally replacing them with an implant with a smaller base diameter will not correct the problem and will actually make it worse.  With smaller implants in place when you lay down the implants will fall even more off to the side.  Capsule work whether a capsulopexy or capsular floor advancement can be done under local anesthesia on the right patient.  I usually have my patients take an oral sedative 30 minutes prior to the operation and this helps them tolerate the procedure.  If extensive capsular work is required then local anesthesia may not be the right choice.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast augmentation revision

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Although not perfect I think they look pretty good. They may be a bit wide for your frame but they are not so wide that they become squared. More is the enemy of better and each operation under local or general anesthesia stimulates scar tissue. I would strongly recommend against additional surgery unless there is a specific problem like capsular contracture, bottoming out, asymmetric inframammary folds etc (gross tuning). Your posted photos are not sufficient to make any specific recommendations. The frontal view shows the left fold lower than the right but it is impossible to see if that is due to the torso being tilted to the left. I think fine tuning surgery creates more problems than it fixes.

I bet there are a lot of women out there who would love to have the look you currently have.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Don't compromise a result just to

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Implant revision is a very, very difficult procedure and should not be taken lightly.  You are way too big and would benefit from substantially smaller implants.  This would likely necessitate some capsule tightening or even a lift to get the optimal result.  BUT the capsule work and/or lift would be difficult to do with just a local anesthetic. 

You might get lucky with just an implant in and implant out under local but then again, you may not and then need yet another revision. 

Remember that revision begets revision and you should give your surgeon every opportunity possible to get this right the second time around even if that means the expense of an anesthesia provider.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

450-350 with Local or GA and Capsule Work?

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The drawback is if the educated guess is wrong, and some capsule tightening is needed, that would be difficult to do properly under local alone. 

Some recommendations can only be made based upon an actual examination, but I might consider using a moderate plus implant to maintain the width, assuming that was a reasonably chosen implant width from the start. That would lessen the chance of needing capsule tightening. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Capsule Work Necessary with Downsizing of Breast Implants?

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Thank you for the question and pictures.

 If you are experiencing breast implant displacement;  for example the breast implants move to the side  significantly  when you lie down, capsulorraphy surgery may be helpful to you.  Since you are downsizing breast implants and the breast implants already are already "too far out”, capsulorraphy may be indicated nevertheless.  Obviously, much will depend on your physical examination and goals.  Communicate these goals carefully with your plastic surgeon to  increase the odds that you are satisfied with the outcome of the procedure, and that further surgery will not become necessary.

With the understanding that practices varies significantly, in my practice, these procedures  would be performed under general anesthesia .

 I hope this helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.