Not "full" ...bigger implant needed or revision to mastopexy? (Photo)

I had a a breast lift with aug., replacing my 16 year old 270 cc saline teardrop size 36C implants with 450cc round mentor silicone implants size 36D I asked for my breasts to be closer together & fuller at the upper pole. It's only been 6 weeks but I'm already feeling I will need a revision at the 6 month marker. Would a "high profile" implant work better as opposed to the round textured ones I have now? Would increasing from my 450cc to 600cc give me the fullness I'm looking for? Thank You!

Doctor Answers 3

6 weeks post-op breast lift plus larger implants--still not as full as wishes.

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Thanks for your question and photos. They show an outstanding breast lift result with perfectly-positioned textured implants. They need to be perfectly positioned, since textured implants are designed to adhere to the breast tissues that comprise your pockets, and therefore do not drop or settle over time as smooth implants do. Without knowing who your surgeon is, I would say s/he did a fabulous technical job of revising your previous augmentation to breast lift plus new, larger implants.

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

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It's not unusual for patients to concerned about their aesthetic result following the combination of breast augmentation and breast lift surgery. During the immediate post-operative period, swelling, muscle spasm and wound healing all negatively impact the appearance of a woman's breast. As swelling resolves, muscles relax and the inflammation associated with healing resolves, the shape and appearance of the breast will change.

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.

Not "full" ...bigger implant needed or revision to mastopexy?

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I am sorry to hear about the concerns you have, early on after breast augmentation/lifting revisionary surgery. Although definitive advice would need to wait until you are many months out of surgery, some general thoughts may be helpful to you. Sometimes, patients in your situation, benefit from a combination of breast implant exchange ( more volume/different profile), capsulorraphy (internal suture “repair” of the breast implant capsules),  possibly the use of acellular dermal matrix or other supportive material and/or revisionary mastopexy surgery.  These maneuvers may be necessary to achieve the superior pole volume that many patients seek to achieve. I hope this, and the attached link, dedicated to revisionary breast surgery concerns, help. Best wishes.

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.