My implants are too wide - Will a pocket revision alone fix the medial fullness and shape? (Photos)

Question

I had a breast augmentation with Motiva ergo mini 220cc implants. The projection of the implants is fine bht i hate the width. I was fairly flat before with a wide cleavage. I do not like the inner fullness and cleavage i was given and never asked for this. I wanted a smaller implant but was told this is the size i needed. Now im looking at either a pocket adjustment or revision with smaller cc’s. Will a pocket revision alone fix the medial fullness and shape or do i need to downsize implants?

Mehmet Ozdemir, MD · Answer

It is clear from your photos that you are experiencing symmastia , or what is commonly called "bread-loafing," where the breast implants have migrated too close to the midline, causing the skin over your sternum to lift and creating that unwanted medial fullness. While the Motiva Ergo Mini 220cc is a low-projection, wider-base implant designed for a natural look, in your case, the internal pockets were likely over-dissected or the tissue simply gave way, allowing the implants to merge in the center. A pocket revision (capsulorrhaphy) alone is usually not the best long-term fix for this issue because the "stretched" skin in the center often remains loose; to truly restore your cleavage gap and narrow the look of the breasts, you will likely need to downsize to a narrower-base implant in combination with internal sutures to reinforce the medial walls of the pockets. This two-pronged approach&mdash;tightening the internal space while using a smaller-diameter device&mdash;is the most reliable way to create the defined, separate shape you were originally hoping for.

Jeffrey M. Darrow, MD · Answer

You stated you wanted a smaller implant originally, so that should be your 1st choice.  A smaller implant should have less width so would reduce the fullness in your cleavage.  Ask your plastic surgeon if changing to a smaller High Profile implant could maintain your projection and reduce your width, which would address both your concerns.  This simple exchange may help you avoid adjusting your pocket as reducing the width of the implant will allow the implants to settle to the outside part of your pocket, naturally widening your cleavage.  Best wishes.

Frank Agullo, MD · Answer

Had a patient earlier this year with Motiva ergo minis at 220 in the same spot. Pocket revision alone sharpened her lateral edge and softened her cleavage, but made her wider.

You would probably need to downsize and consider softening the cleavage with fat grafting. 
#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

Yily De Los Santos, MD · Answer

What you’re describing is usually more related to the implant width and pocket position than just the volume in cc.

Excess inner fullness (more cleavage than desired) can happen when the pocket extends too far medially or when the implant is too wide for your chest.

A pocket revision can help in some cases, especially if the issue is mainly positioning. However, if the implant itself is too wide for your anatomy, adjusting the pocket alone may not fully achieve the shape you want.

In these situations, a more balanced result is often achieved by combining:
— Pocket adjustment
— Implants with a narrower base (not necessarily much smaller in volume, but better proportioned)

Projection can often be maintained, but implant diameter is what most influences that medial fullness.

The goal is to match the implant to your anatomy, rather than relying on pocket changes alone to correct the shape.

Mats Hagstrom, MD (license on probation) · Answer

Your breast sit really wide on your chest.
This is going to be amplified with the projection of implants.
If your implants sit farther apart, then they’ll be more space between your breast and the wideness of your breast will be amplified.
Your candidacy for breast augmentation was limited because of the position of your breast on your chest wall.
The bigger the implants, the more this becomes obvious.
Your best option is to go with a smaller implant.
I don’t think you should change the pocket all that much.
 I think it’s going to be difficult to give you the look you want because your candidacy for the procedure was limited in the first place. You are correct in that a smaller implant would’ve been better.
Downsizing the implants is probably your best option.
I don’t think manipulating the pocket is going to do all that much.
Best,
Mats Hagstrom MD

My implants are too wide - Will a pocket revision alone fix the medial fullness and shape? (Photos)

Answers (6)

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