Implant softness & width - what can be done to make them look more natural? (Photos)

Question

I had motiva ergo mini 220cc implants placed subfascially with a lower sinking Lift only. 5 years ago I had a lollipop lift with no implants. This is my current result and I’m unhappy with how full they are medially and how unnatural they look. I’ve considered a revision with capsule correction to move them laterally and possibly downsize one or two sizes. My concern is when I lay down they look like disks on my chest and not natural at all: what can be done to help them look more natural and like small, pretty breasts?

Frank Agullo, MD · Answer

Your "disks on my chest" read is correct, and you are reading it exactly right. Subfascial implants sit on top of the pectoralis rather than below. That means the implants cannot tuck behind the pectoral muscle when you lie on your back the way they would if they were submuscular. When you add in a prior lollipop and a thinned upper envelope, the disk shape lying flat is embedded in the construction, not something that softens into your anatomy over time, even after the swelling resolves.

In your situation, if I am redoing the implants the surgery would be: one procedure, a medial capsulorrhaphy (closing the inner side of the pocket with sutures so the implants cannot live as far center), paired with a lateral pocket release so the implants are able to slide laterally onto the outer chest. A downsize, narrower in width than the ergo mini 220 and lower in profile, so you flatten out less when you are lying down. And a hybrid fat graft over the superior medial edge of the implants to disguise the implant's borders under your thin tissue.

You might consider a plane change to dual plane if your envelope continues to thin. Do not skip the fat graft. The amount harvested is small. The cosmetic payoff is much larger.

#StayBeautiful,

@RealDrWorldWide

Daniel Barrett, MD · Answer

Dear Celebrated5049,

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

Carlos Alberto Ríos García, MD · Answer

Based on your photos and description, I do understand what you mean by the implants appearing very medial, round, and somewhat “stuck on” the chest &mdash; especially when lying down. The good news is that your concerns are understandable and, in many cases, potentially improvable with revision surgery.
Several factors may be contributing to the appearance:
* implant width relative to your frame* implant projection and cohesiveness* subfascial placement* previous breast lift anatomy* tight medial pocket positioning* and limited soft tissue coverage
Your implants do not appear excessively large, but they do appear relatively prominent for your chest anatomy and soft tissue thickness, which can create that “disc” effect instead of a softer natural slope.
You are also describing something very important aesthetically: not necessarily wanting “smaller breasts,” but wanting breasts that move and rest more naturally.
In many patients, achieving a softer and more natural result may involve some combination of:
* downsizing implant volume* changing implant dimensions* pocket adjustment/capsule revision* lateral pocket balancing* changing implant plane* or adding fat grafting for softer transitions and camouflage
However, moving implants too far laterally also carries risks, including loss of cleavage or an “empty center” appearance, so revision planning has to be very precise and individualized.
In our practice, we frequently evaluate patients seeking a more natural revision result after augmentation, and one of the most important parts of revision surgery is balancing implant size, tissue characteristics, chest anatomy, and patient goals &mdash; not simply making the implants smaller.
Your result is not “bad” or alarming medically, but I do think your aesthetic concerns are valid and worth discussing with an experienced breast revision surgeon if this continues affecting your confidence and satisfaction with the result.

Mehmet Ozdemir, MD · Answer

I completely understand your frustration when you choose a low-profile implant, you expect a soft, natural blend rather than rigid "disks" that don't move when you lie down. This stiff, overly medial look happens when the implant pocket is slightly over-dissected toward the center or restricted by a tight tissue capsule, preventing the implants from naturally settling outward. To fix this and achieve a softer, smaller look, a surgical revision is your best option: a surgeon can perform an internal capsule repair (capsulorrhaphy) to close off the excess inner fullness, open up space laterally, and downsize you to a smaller implant. This combination will stop the harsh edges and give you the natural, graceful contour you are looking for.

Waylon Zeng, MD · Answer

Hi there, thanks for your question and sharing your photos! Subfascial breast augmentation using motiva implants is ai great procedure with minimal downtime and great results. However, with super thin patients, it is hard to hide the edges of the implant. While Motiva is much better than other implant companies in creating a natural appearing OTM augmentation, it will still be noticeable in many skinny patients. In your situation, the implant actually looks like it's in a good position but just too noticeable around the edges especially at the top and the center. The best option in this situation would be to inject some fat to soften the upper chest/upper pole region and blend in the transition from the chest to the implant. Alternatively, the other route would be to convert your current augmentation to under the muscle. This has the main downside of having a longer recovery as you are essentially redoing the entire augmentation. Hope that helps!

Implant softness & width - what can be done to make them look more natural? (Photos)

Answers (5)

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