Unhappy with size, revision to 615 cc ultra high projection? (Photo)

Question

8 months ago I had my 2nd breast augmentation (450cc round, high profile, under). Due to my prominent sternum they appear small. The lack of projection due to the sternum in the upper part bothers me. I'd like 615 uhp, diameter would be 1 cm larger than now. Do you think its worth and make a noticeable difference or is it too risky? Would symmastia be a problem if I go with a 615cc and a 1cm wider diameter? Can something be done to prevent from symmastia when they put in the bigger implant?

Larry S. Nichter, MD, MS, FACS · Answer

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.

Steven Wallach, MD · Answer

Any revisional surgery opens you up for potential complications.  Think hard and long about whether it is worth it to you. Your results look nice.

Darryl J. Blinski, MD · Answer

Best to see a few boarded PSs in person fr this difficult decision. Plus you need to correct asymmetry in volume also.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  You are wise in being concerned about safety considerations (avoidance of complications) with revisionary breast surgery. Careful physical examination would be necessary to determine whether re augmentation with larger breast implants can be performed safely. Ultimately, careful selection of your plastic surgeon and careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical.The best way to "prevent symmastia" is to avoid over dissection ( or any dissection at all in some cases) in the medial breast area and to select appropriate breast implant size/profile.Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery 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 are 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 "up a cup size” or "D or DD cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on 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 chosen plastic surgeon to work with you in determining the best plan to achieve your goals.I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps. Best wishes.

Daniel Greenwald, MD (in memoriam) · Answer

You appear to have beautiful breasts with an excellent cosmetic result.  Symmetry and contour are quite good. Each 100 cc change is about one half of a bra cup size, so choose accordingly.  450 to 615 will be a significant change, but your chest and skin envelopes should be able to handle this.  Wrinkling and rippling may be an issue with the ultra high profile implants, so you may want to consider a shaped construct like the Allergan 410 FF series.

Unhappy with size, revision to 615 cc ultra high projection? (Photo)

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