Can Internal Sutures Create a Fake Look From A Natural One? (photo)

I got 650cc Mentor Mod+ shells overfilled to 800cc, under the muscle, in February 2012. I started with a perky small B cup. I wanted an obviously fake look but ended up with an extremely natural look. Zero upper pole, flat cleavage, and a bad "hang". Is it possible to get internal sutures to create a fake look with rounded upper pole from the natural results I have now? I like my size so I'd rather not go through an implant exchange if my issue can be fixed another way. Thank you!

Doctor Answers 10

For a an upper pole fullness look

Hi! Thank you for your question.

I am Dr. Speron, a proud member of both the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS).  I am also certified with the American Board of Plastic Surgery.

It is very difficult in some women to achieve the look that they desire due to the tendency of their tissue to relax or stretch under the weight of an implant. The amount of breast tissue you have prior to augmentation determines to a large part whether you get the "fake" look or not. The natural tissue camouflages the implant. In general, larger implants will give more upper pole fullness such as saline filled implants and Anatomic shaped implants.

One option is to have a breast lift which will benefit from an implant when it is necessary to add fullness to the upper portion of the breast. Internal sutures can help a lot but effect might be minimal, it depends on your tissue strength.
Your plastic surgeon must evaluate you and see what his thoughts are on the lift with an implant.

I have provided direct link below for additional information as well as a lot of before and after pictures. If you have any further questions, please feel free to call us at 847.696.9900 for a private consultation.

Best of luck and have a great day!
Dr. Speron

Chicago Plastic Surgeon
5.0 out of 5 stars 1 review

Creating sufficient internal support is difficult (in your implant fill range)

Roseishish: Do remember that a saline implant which is overfilled, will always project more, be more narrow (than a midrange implant) feel harder and inevitably dislocate because of its weight.  Internal suture capsulorrhaphy would undoubtedly fail, rapidly because of the volume you have selected.  I would consider the addition of Strattice (porcine acellular cadaveric dermal matrix), which is sutured internally, creating a "hammock" effect, upon which the implant rests.  The main reason why it isn't utilized more frequently, is its cost, which is exorbitantly high.  On the horizon is a product from Allergan, Sirica, which will be used in similar fashion, once the price point is established.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Over the muscle tends to give a more "fake" look

We usually place implants under the muscle because most people want a natural look and this position usually looks more natural. You may want to consider changing your implants to over the muscle. This may give you the look you want. Internal sutures will not help much and may cause problems.

Matthew Schulman, MD
New York Plastic Surgeon
4.9 out of 5 stars 324 reviews

Wanted fake... got natural

I'm sorry to hear you did not achieve your result that you expected.  Was your surgeon aware of this?  Regardless, if you had maintained the fake upper pole fullness, your nipples would have likely been pointing to your toes, leaving you with a different kind of dissatisfaction.  The photo you included shows an extreme result that I could not achieve if she had any natural breast tissue of her own as it would droop over the implant.  If you were in my office, I would suggest you not pursue more surgery and use push up bras to achieve the look you desire.  If your happiness depends on having that look when undressed, you are looking at a breast lift (with the scars that come with it) and repositioning of your implant higher which would require a bra 24/7 for 6-8 weeks, in addition to the costs and acceptance of all of the risks of surgery again.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Achieving “Fake” look after Breast Augmentation?

Thank you for the question. I think this is a question that may benefit many patients who are trying to achieve a “full, round, fake” looking result after breast augmentation surgery.

 Much of what a patient's breasts will look like after breast augmentation surgery will depend heavily on how much breast tissue they started with. For example, in your case, it is clear that you started with a lot of native breast tissue initially. Therefore, despite using relatively large  and overfilled saline breast implants,  you are not able to “see” the end results you are looking for,  because of the presence of the overlying breast tissue.

 To achieve the appearance of the young lady's breasts in your goal pictures, you would need to have a significant amount of their own breast skin/tissue removed ( breast lifting),  an operation that I would not recommend to you.

In your case, capsulorraphy surgery (internal sutures) will be minimally helpful at best.

 I hope this helps you and others considering breast augmentation to achieve the  "full, round” look.  You may also find the attached link helpful.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Implants overfilled to 800 cc

The photo of the goal person shows someone wearing a bra underneath the breasts lbasically supporting them in a very  fake way. The size of the implants and the quality of your tissue prevent this from occurring.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Disappointment with natural breast shape

Your overfilled 650cc implants will behave like a high profile implant and become rather firm and round, however the skin envelope you were blessed with is likely to relax and settle with increasing loss of upper pole projection no matter how full you go. Sorry, but what you are asking for just will not happen.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Internal Sutures


Your desire for that particular appearance (of the model you posted) will most likely never happen, regardless of what procedure is performed on your breasts. This is because you've chosen a model who is proportionately very small compared to her implants. You are near the upper limits in size, and would still not have her proportions if you changed your implants to the largest available and overfilled them to roughly 1000 cc, which is about 20% larger than your current size.

Internal sutures only lift the implant up, and if nothing else is performed, your breast tissue and nipples will slide DOWN in a compensatory manner.  This would not be beneficial to you, as your breasts would appear droopy even though you have upper pole fulness. Therefore, in addition to suture plication of the capsule, you would need a breast lift to achieve a satisfactory appearance.

Finally, as you have already experienced, large breast implants have a large impact on your breast tissue, causing expansion and thinning which leads to implant drop out and malposition.  This is especially true with saline implants which have the 'water hammer' effect that amplifies these unwanted characteristics of large implants.  Even with suture plication of the capsule and a breast lift, your result would not be immune to these forces, and you could easily find yourself with a loss of upper pole fullness again.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

A High Full Look Requires A Breast Lift Even With Large Implants

The reason you ended up with the result you now have is the preoperative shape of your breasts, which clearly had some degree of sagging. Only an external breast lift with scars, done either originally or now, will get you closer to the look that you desire. You have too much breast skin for the underlying breast volume, regardless of the size of the implant, to achieve that look without some form of external skin tightening.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Internal suture techniques cannot create upper pole fullness

The greatest determinant of the final breast shape is the preoperative breast shape.  Not every breast can be made to look like any other.  In general, a fake look is best achieved with an overfilled saline implant, often placed over the muscle.  This is not however a common request from patients.  Breast implants will drop over time and if there is extra breast skin prior to the surgery then the implant will certainly drop and create a "hanging" look.  If the breasts are a little droopy before the surgery, the only way to avoid the postop "hang" is to consider a breast lift with a small implant.  Internal suturing is not very effective for making significant changes to the breast shape and will not create new upper pole fullness. 

Jason E. Leedy, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 126 reviews

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.