Surgery 2004. 400 saline mods o/f to 425, 34DD. 5’ 7,” 125-130 lbs. size 4, large ribcage (32”), broad shoulders. Left implant dropped too far early on, right followed. Very unhappywith how far down they sit. Wear/sleep in support bra daily. I’d like to go down to a full C from DD. Would there be a lot of loose skin? Do anatomical cohesives rotate in revisions to go smaller? Input pls on type/size implants for revision, and if feasible to be positioned higher than my current. Thanks!
Implant Size/type for Revision to Go Smaller and Avoid Bottoming out in 50 Yo? (photo)
Doctor Answers 6
Revision breast augmentation should make you better.
I agree completely that smaller implants (300 cc's) will be much better. You want smooth walled, round, moderate PLUS profile, silicone gel implants. And of course, the folds need to be raised to correct bottoming out.
Breast Implant Revision to Correct Bottoming Out
Dear Nancy, Thank you for your photographs and question. From your pictures I see 3 issues. The inframammary fold is too low with the bottoming out you describe. The edges of your implants are visible in the upper chest , giving an artificial appearance and shape. The size is too large for your frame to look natural. I suspect that the weight of the implant may have thinned your tissues at the bottom and that you can feel the bottom of your breast disc, like a double bubble phenomenon. A smaller implant is advisable. You can decide with your surgeon how much smaller to go. A dual plane (submuscular) placement of the implant will help to hide the edges of the implant. You may need more than a capsolorrhaphy to secure the inframmary fold. A material such as Strattice or Alloderm might be required to keep the fold in its elevated position. You may also reqire some form of a lift if your skin envelope is stretched out from 8 years of the large implants. You can absolutely get a better result, but the decision making may be complex. Find an experienced surgeon you can communicate well with.
Downsize with an anatomical implant
The anatomical very cohesive implant will have a tendency to rotate or shift if the pocket does not fit the implant well. We would suggest an Allergan style 10 gel, about 304cc on your broad chest, though the time to judge is at surgery. A new submuscular pocket would also be ideal if possible, otherwise repair of the capsule should even the pockets.
Best of luck, peterejohnsonmd.com
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Breast Implant Downsizing
From a look at your preop photos your breast development was always a little low on your chest and it does not look like your nipple position has changed much so I definitely would not choose a lift at this point. The distance from your nipples to the bottom of the breast does look too long and I think Dr. Pousti's suggestion that you get that corrected with an inferior capsulorrhaphy would be correct. It's not possible to really know what size would work best without an exam but in general I think if you don't reduce your volume by at least 75-100 cc you may not feel like there is much of a change. Finally, stick wiith the round implants, overall they give the best results.
Revisionary Surgery Candidate?
Thank you for your question and pictures.
Looks like you are a good candidate for revisionary breast surgery. Inferior capsulorrhaphy(permanent suture support of the lower breast capsule) would help with improving the placement of the breast implants on your chest wall. Downsizing of the implants may also assist you with achieving your goals. I ask patients to bring in photos of what they want to achieve and I use temporary sizers while in the operating room to get as close as possible to the patient's goals.
I prefer to use round implants vs. anatomic because the anatomic implant may shift and therefore change the breast shape (necessitating further surgery).
I hope this helps.
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