I used to be a 32A. 335 on the left and 355 on the right, I am now a 32D. Should I get implant exchange and fat graft? (Photos)

Dear dreamygal00,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

At size 32, each 100 cc of implant corresponds to 1 cup size change. To go from a D to a DD would require 100 cc's more for each implant. Your nipples are slightly pointing outward and your breasts are low on the chest wall. You may be beginning to bottom out slightly. Larger implants can make the situation worse. At this time, I believe you have a great result and adding larger implants will make your situation worse not better.

Best Wishes,

Gary Horndeski, M.D.

Hello and thank you for your question. If your goal is to achieve more cleavage, I would recommend fat grafting. This is a better technique for augmenting specific areas of the breast, most commonly the medial and upper portions. If the distance between your native breasts was on the wider side, larger implants will not correct us. Any attempt to move the implants closer together may lead to symmastia, which is very difficult to correct. Good luck. I hope this helps.

Thank you for your question. You are lucky that you have attractive breast as they are. If you want more cleavage, then I would perform a internal bra/capsulorrhaphy procedure. I wrote the very first paper on how to do this in 1999. I have been in practice for over 30 years and revisionary breast surgery is a large part of my practice. I do not think that fat grafting will be of any benefit. Best wishes to you.

Dear Dreamygal,
Thanks for posting your pictures, though seeing the before pictures would be helpful. From observing your pictures you appear to be asymmetrical in regard to breasts size. Right breast is noticeably larger than left breast by maybe half size. You will have to be measured to ascertain that you are 32 D cup size, because the different photos reveal different impressions. If indeed you are 32 D cup size and you want to be symmetrical 32DD you will have to change the implants to 475 cc on the right and 525 cc on the left. In regard to the wide cleavage, it is not because of your anatomy, but rather because the medial muscle was not dissected enough towards the midline. So you will need medial capsulotomy (scar release) to get nice cleavage and you will need also superior capsulotomy to accommodate the larger implants and get nice upper slope. To achieve it the best approach is via sub areola incision.
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 in the photo gallery to make sure that they are numerous, consistent and attractive with nice cleavage, symmetrical, nice projection and natural looking.
Best of luck,
Dr Widder
widderplasticsurgery.com

I do not recommend going much bigger, but the fat transfer, assuming you have any donor fat, could be helpful in the cleavage area.

Based on your nicely post of photos, I agree you could have an implant exchange to 450 to 500 cc range high profile implants with fat grafting after Lipo to correct issues in your breast. Expect fees to range from $8000-$15,000. Best of virtual consultant with.