Can I have advice on exchanging implant size and profile & opinion on BWD?

In
your before photograph, your nipples are too low and too lateral. At augmentation, your implants had to be
centered underneath the nipples. This
resulted in the implants placed too low and too lateral. Without the support of the underlying muscle,
your implants have descended inferiorly and laterally even more. The solution to your problem is to use a
technique called Implant Exchange with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage. Aligning the areola, breast tissue and
implant over the bony prominence of the chest wall maximizes anterior
projection with a minimal size implant.
Small round textured silicone gel implants placed retro-pectoral look
and feel more natural, are more stable, less likely to ripple or have
complications needing revision. Implant
profile is irrelevant in the retro-pectoral position since the muscle
compresses it. 22% of women who undergo
breast augmentation alone require revision within 2 years because they are
dissatisfied with the result. Frequent
causes of dissatisfaction are over implantation and failure to do a
simultaneous lift when necessary. Best Wishes,Gary Horndeski, M.D.

What you have is a very predictable and typical result from an ultra high profile implant in the dual plane technique ( and frankly most women are very happy with this sort of result).  My advise to you is to either decide that the result is acceptable or do something different.  As Albert Einstein said , the definition of insanity is doing the same thing over and over and expecting different results.  The reality is that most breast augmentations look like yours and most women are happy.  I agree with your aesthetic opinion and do not like the low and separated "stuck on " appearance.This is exactly the reason that I do things very differently from mainstream plastic surgery.  I use a technique called Cold-Subfascial Breast AugmentationR and I have NEVER used a moderate, high and certainly not UHP implant because I want to create a natural appearing beautiful form.  Today I only use relatively low profile implants that are form stable "gummy bear" type and have an anatomic shape.  The results of this are forms that you simply will not encounter with dual-plane submuscular techniques.  The muscle ensures that the implants spread apart and bottom out.  Using fascia takes the muscular forces out of the picture and creates a long term support for the implant allowing a natural slope towards midline with no separation and a wide slope laterallly that disappears into the axillary fold unlike the disjunction between the implant and pectoral fold present in submuscular and dual plane techniques.  To be clear, your result is a very good  one if you look at the results, expectations and patient satisfaction of mainstream augmentation, it seems that the problem is that you do not like the "augmented look" that is actually very popular in celebrities and pop culture.  Your average augmentation patient is likely to be happy with this result although I would not be happy generating such a result.  You fall into a subset of patients looking for a natural appearing augmentation.  I would look at before and after pictures of doctors offering subfascial placement and find one that has results that suit your taste or just leave it for now.  You are only 4 months out and things will change a bit.  If you do change the implants I would recommend consideration of an Allergan 410 FM series implant.  The other option would be fat grafting around the implants but it looks like you dont have much extra fat.  I hope this helps!All the best,Rian A. Maercks M.D.

I agree that  a wider implant may look nicer and the ultra high is probably too narrow at 9cm. Of course you may want to keep what you have to save money as the result looks fine on you except for the bottoming out part. The more surgery you have the more chance for problems! Good Luck!

Generally speaking, I am hesitant to modify the pocket with permanent sutures to raise the implant on a breast augmentation revision.  I believe the preferred approach would be a neopectoral ("new pocket") with possible mesh reinforcement of the lower implant as needed.  It is very difficult to create a round breast crease with permanent sutures.  I do this regulary with reconstruction patients but would not bother in the case of an augmentation.

Thank you for the photos and question.  The biggest problem I see is aside from the bottoming out your incision is low, which complicates the capsule repair (capsulorraphy).  If the capsulorraphy is planned I would consider using Alloderm or Strattice or Seri to support the lower pole.  You might also consider going with a textured implant to maintain the position, whether it be round or preferably the shaped textured Allergan 410's or Sientra.  Discuss this with your plastic surgeon.  Good luck, Dr. Schuster from Boca Raton.

Thank you for the question and helpful series of pictures.   I think that you and your plastic surgeon have a good game plan with the planned capsulorrhaphy surgery.  I also think that your goal pictures  demonstrate realistic expectations.  Generally speaking, the best online advice I can give to ladies who are considering  revisionary breast augmentation surgery (regarding breast implant size/profile selection) is:1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as  “natural” or “C or D cup”  etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.I hope this (and the attached link) help.

Thanks for sharing your question and pictures.It is hard to tell without performing and exam, but it seems that the original implant may have been narrow for your frame.  A slightly wider base diameter implant seems like it might help.  There are many factors in selection of a breast implant for a patient and a detailed consultation with a board certified plastic surgeon is essential