Will my nipples sit lower after implant exchange? (Photo)

Hello and thank you for your question. Dual plane refers to the the fact that the implant is under the muscle for upper portion implant and in a subcutaneous plane (i.e. uncovered by the muscle) in the lower portion. It is effectively considered "under the muscle". It sounds like the new surgeon will plan on keeping the existing plane and this will not affect the position of your nipple/areolar complex. To get more fullness in the upper portion of the breasts, you would likely need to opt for a higher profile implant with a more cohesive (firmer) gel. These are all good questions to review you with your surgeon prior to your planned surgery. Good luck on your journey!

At this time, your breasts are wider than your chest wall, they are falling inferior and laterally and are bottoming out. I would recommend plication laterally and inferiorly to push the breasts more medially and higher to increase the cleavage and upper pole fullness. Also, smaller implants with a circumareola lift would be better for you.

Best Wishes,

Gary Horndeski, M.D.

Dual plane means is that the top of the implant is under the muscle and the bottom is covered only by breast tissue. It is nearly impossible for the muscle to completely cover the implant, and it's not possible to stretch it back over an implant this large once the muscle has been previously released. I imaging your surgeon is just keeping the existing pocket and is saying "under the muscle" to distinguish from moving it to above the muscle.

Your nipple position looks good, so I do not think a lift is indicated. Everyone has a capsule of scar tissue surrounding your implant. This layer of tissue can sometimes be tightened (with sutures or cautery) to allow for the implant to sit a little higher and closer to the center of the chest. I usually have patients try on sizers to see how much additional volume they prefer. Generally, 100-150mL will give fullness without significantly changing cup size. The newer implants are overfilled (like Inspira implants), which will maintain fullness at the top of the implant better than a "classic fill" implant.

As far as implant sizing goes, that is a difficult question to answer online without a proper exam as well as a long discussion and evaluation of desired photos. Your NAC appears to be in a good position, however what sets off the asymmetry is that your right breast in the photos has a longer NAC to crease distance. Difficult to tell if that is because of a difference in the crease positioning between the two breasts or you just have more lower pole stretch on that side. If it is the crease then positioning the crease during your surgery will help with the issue. If it is more lower pole skin then removing some of the skin with inferior mastopexy would be the treatment.

Hope that helps, good luck on your surgery.

Your implants are bottoming out some which makes the nipples look somewhat high. If the inferior pocket is tighten, this will correct the nipple problem. Do not go larger or you will bottom out again.

Based on your current photos your nipples are sitting at the correct position and won't likely lower with an exchange. Dual plane simply means that part of your implant (the upper portion) is covered by muscle. It's difficult to recommend an implant without examining you or knowing more about your goals for surgery. Your current result is nice so I would caution against going too large which can weigh on the breast tissue.

Based on the two posted photos, the result technically is good, but there is not a symmetry to the shape of the breast. The nipple areas are in normal position, and there is more inferior breast tissue on the right breast side in the photo based on photo visualization, I would not recommend changing the dual plane position to a sub muscular position, I would recommend a right breast lift for access and pull with a different volume implant on the left side to gain volume and shape symmetry. The nipple complexes would most likely stay in the same position. From $8000-$15,000. Best of virtual consult with for other opinions either virtually or in person. Regards.

Why are you having an incense exchange?
The only way to get fullness in the upper part of your breast is to use a bigger implant, which going to increase the chance of undesirable side effects, complications and need for further revision surgery.
Alternatively a Breast lift could be done.
Personally, I might be inclined to recommend leaving good enough alone for now.
A dual plan augmentation means the upper part of the implant is covered by the pectoralis muscle, and the lower part of the implant is not.
It means the muscle has been transfected.
The pectoralis muscle generally always needs to be at least partially cut or separated from the chest wall in the infer your aspect in order for the implant to sit in the correct position position.
Personally, I like to leave as much of the Pralis muscle attached to the chest wall as possible, and generally try to cut as little of the pectoralis muscle as possible.
Once to porous muscle is cut The muscle is no longer supporting the weight of the implant.
Using large implants can put pressure on the skin stretching out the lower half of the breast.
This may be happening on your right side to some degree.
It’s not an easy situation without doing more advance to work.
Opting for bigger implants is going to increase the chance of having problems down the road.
You should have a clear understanding of what your surgeon is planning to do before scheduling surgery.
As I mentioned previously, at this point, I would probably simply hold off recognizing that improving your shape may be more difficult than you anticipate.
Best,
Mats Hagstrom MD