Not "full" ...bigger implant needed or revision to mastopexy? (Photo)
Doctor Answers 3
6 weeks post-op breast lift plus larger implants--still not as full as wishes.
The problem is, this wonderful result is not what you wanted!
You wanted more fullness (enough to give you more upper pole projection) and closer cleavage. Perfectly reasonable, BTW.
Your proposed solution--"high profile" implants--would NOT correct your concerns. Let's say, for example, that your surgeon used the same volume implants, but in a higher profile. This would mean narrower diameter implants, with more projection. Since round implants have the same diameter vertically as horizontally, how does a narrower horizontal diameter and a shorter vertical diameter give you implants that come closer together in the midline, or more implant in the subclavicular (upper pole) area? Narrower = wider cleavage, and even less implant from the crease position (which is fixed) to the top of the implants = LESS upper pole fullness!
You DO, however, have part of the actual solution to your concern--larger implants which have both wider horizontal diameter and vertical height (for a given volume) since they are round. Projection will increase with larger size implants, regardless of profile, but the widest (moderate profile) implants in the desired large(r) size will also have the best upper pole fullness.
I have read too many times here on RealSelf that HP (high profile) implants give more upper pole fullness. Respected colleagues who are fully-trained and ABPS-certified plastic surgeons will make this statement, and when I read this I wonder if they see their patients after the (narrow, more projecting) implants drop into position several weeks and months post op, when the narrow base and shorter vertical height give widened cleavage and LESS upper pole fullness. Wider, moderate profile implants give closest cleavage and also have the increased vertical diameter that yields more retained upper pole fullness when the implant is in its "final" position.
HP implants give more projection and the appearance of "more upper pole fullness" when they are still high and haven't yet dropped! But when they drop they stick out more, but have a concave "shelf" in the upper pole. NO WAY is this "more upper pole fullness" in the long term! Bigger (round) implants will have more width AND more vertical height, regardless of profile, and for a given size, moderate has more width and vertical height than moderate plus, which has more width and vertical height than HP.
HP implants do NOT give "more upper pole fullness!" They give more projection at the cost of both width AND vertical height for a given volume!
Thus, moderate plus implants will have closer cleavage and more upper pole fullness than HP implants, and if the diameters fit the pocket dimension, moderate profile implants will have even MORE horizontal and vertical diameter and therefore more close cleavage and upper pole fullness. Even after the implants have dropped into their final position!
I do agree with larger implants, and would agree with your suggestion of 600cc or so. Make sure your surgeon uses the widest profile that still fits your pocket base diameter, and opens the pocket superiorly to allow movement and softness (with smooth implants). The high, round, "Baywatch coconut look is possible with adequate volume and a nice push-up bra, but to achieve this with implants alone, you would need (and do NOT want) capsular contracture.
I would recommend smooth round cohesive silicone gel implants in the submuscular plane, but if yours are submammary (thus more appropriate for textured), I would probably use the same pockets. Talk to your surgeon, but do wait for 6 months. Best wishes! Dr. Tholen
Too Early For Revisional Surgery
For this reason, it's appropriate to delay any type of revisional surgery for at least six months. Although, you appear to have an excellent overall result, you're still concerned about the size and shape of your breasts. It's important to understand that patients always have different starting points, anatomic findings and aesthetic goals.
If you're still not happy after six months, it might be reasonable to place larger breast implants to create more upper breast fullness. This might necessitate additional breast lifting as well.
It's, therefore, important to maintain good communication with your plastic surgeon. After six months your surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.