300cc saline mod overfilled to 360cc implants-SUB FASCIAL plane. I am just not satisfied, I feel that i have no upper pole fullness making them look too round,they aren't big enough and they look strange when i lift my hands above my head or lay on my back, the gap in between is wide and i now am rippling on the top. They also feel pretty hard. What can i do to acheive the fuller, natural look and feel that i am wanting? I really would like to stay with saline if possible for safety. Thank you.
Should I Have Gone Behind the Muscle?
Doctor Answers 10
Just not satisfied with my subfacial saline Breast Implants - Not big enough, too round, rippling at the top etc
Regarding: "Should I Have Gone Behind the Muscle?
300cc saline mod overfilled to 360cc implants-SUB FASCIAL plane. I am just not satisfied, I feel that i have no upper pole fullness making them look too round,they aren't big enough and they look strange when i lift my hands above my head or lay on my back, the gap in between is wide and i now am rippling on the top. They also feel pretty hard. What can i do to acheive the fuller, natural look and feel that i am wanting? I really would like to stay with saline if possible for safety. Thank you."
The short answer to - is Probably.
The reason why I am not sure is because, respectfully, you do not seem to understand what can and cannot be achieved with Breast Augmentation and as a result it would be hard to deliver a result that may satisfy you.
The statement " i have no upper pole fullness making them look too round" makes no sense. Upper pole fullness is a full rounding of the top half of the breast brought about by the underlying (usually over the muscle) implant. If they are "too round" - you manifest too much upper pole fullness not a lack of it.
As to "they aren't big enough" - there ARE physical limitations in what size implant can be placed in someone (just like a 400 pound man would not comfortably fit your average airline seat) and there are cosmetic limitations. You complain that " now am rippling on the top". To avoid seeing implant ripples your tissues (muscle and breast) SHOULD cover the implants. When they do not, as when you lift your arms and uncover the bottom of the breasts they WILL " look strange" because the implant shell and its ripples are uncovered and close to the skin. Putting larger implants when you do not have enough tissue to cover these implants would guarantee "stranger" less natural looking breasts.
The gap between the breasts is dictated by your chest wall anatomy. It CAN be narrowed somewhat with wider implants But the wider the implant, the more it extends under the breast cover exposing the ripples and the heavier it will be resulting in faster skin stretching and sagging. Attempting to create "cleavage" with wide implants usually fails resulting in large sagging breasts and "uni boobs". Nothing attractive about it and hard to correct.
You COULD have larger, less rippling implants if you had silicone gel implants placed under the muscle. There is nothing inherently safer about saline implants compared to silicone filled implants. Silicone filled implants are lighter and ripple less than saline. The hard feeling you are complaining of is due to the added fill of the saline implant. That will not happen with gel implants.
You should educate yourself on all your options before having another operation which is likely to worsen your appearance.
Dr. Peter Aldea
Breast Implant Pockets: Risks and Beneftis
Breast implants can be placed in 3 pockets: on top of the muscle, under the muscle or under the fascia. There are advantages and disadvantages to each, which should be discussed before hand, though the sub-fascial pocket is utilized because of its theoretic combination of advantages of both over and under the muscle, with a shorter recovery and adequate implant coverage. The subfascial plane is likely closer to an over the muscle implant which in your case seems to have revealed the disadvantages of this pocket which includes poor coverage, malposition and rippling. You may as well have a capsular contracture or just an over-filled implant which contributes to the firmness. You may want to try a softer silicone implant over the muscle after the scar tissue is removed or a pocket change with an implant placed under the muscle. I would return to your plastic surgeon to discuss your complaints and figure out a resolution to your fixable problem.
You can't always get what you want
Implants basically make bigger versions of what you started with. What you need to do is prioritize what makes you most unhappy and see what can be improved on your checklist: Sub facial implants offer little if any upper pole camouflage, toss in a saline implant and you get upper pole ripples. If the implant is overfilled past a certain degree to decrease rippling you get shell scalloping and a rounder/faker look. Issues of "safety" aside (most safety issues about silicone gel implants are way over-exaggerated), converting to a submuscular high-profile gel implant may solve some of your issues.
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Confused about breast implants
I can tell from your question that you really don't understand breast implants at all and that your surgeon hasn't made some simple facts clear. Please also understand that some perple's bodies just will not allow them to have the result they want.
First of all, upper pole fullness equates to a round look so going fuller is also going rounder. And both of these are LESS NATURAL so you can't have fullness without roundness and unnaturalness. Hardness comes from overfilling the implants but wrinkling comes from having them above the muscle with thin tissue coverage. If you stay above the muscle you will need tham filled more to decrease the wrinkles and then they will be even harder.
You really need to sit down and think this through because you have so many misunderstandings about implants. Maybe you need a new surgeon who can explain it better or maybe you need to be a better listener.
Implants are not large enough
There are conflicting statements in your question. You say that they look too round but then you state that you want more fullness. You will get LESS upper fullness if you go under the muscle and I would truly caution you about going any larger.
There are numerous increased risks associated with this, and I am sure I will not even touch on half of them, but consider the following.
The size of the implant has been associated with:
1.Increased risk of loss of nipple sensation
2.Increased risk for long term breast ptosis (sagging)
3.Increased risk for chest wall deformation (curving of the ribs)
4.Increased risk of rippling or palpable /visible creases
5.Increased risk of lower pole tissue attenuation (thinning of the tissues of the breast)
6.Increased risk of secondary revisionary procedures
These are a few of the risks off the top of my head. Please discuss with your surgeon.
Most importantly, remember that although you are seeking breast enlargement, many women present complaining of breast overgrowth desiring breast reduction. These women report limited physical activity, neck/back/shoulder pain, shoulder grooving from bra straps, numbness in the fingers, rashes beneath the breasts, etc.
Many of these women feel significant relief with reductions as small as 300 cc yet you are considering adding twice that to your breasts. Think it over carefully.
I hope this helps.
Cleavage depends upon your anatomy and trhe size of the implants. However, if you try to force them, you can have trouble. Upper pole fullness never stays as high as some patients woud like, only a bra pushes them up that high.
Achieving upper pole fullness is often a goal of patients seeking breast augmentation. This is especially true of women after childbirth, breastfeeding or weight loss. Upon reviewing your photos I agree that you are still lacking in some superior pole volume. While a submucular position can be associated with a more subtle and better camoflaged implant the superior poles are often similar in volume to subfacial implants. Given that your goal if to have upper fullness and already of well proportioned implants consider FAT GRAFTING of the upper poles.
Options for Breast Augmentation
Boy, you have opened up a can of worms!
I recommend visiting our website and then click on the blog link. There is a wealth of information on almost every thing you ever want to know about breast and other aesthetic procedures.
Understand the shape of the breast
If you would like to understand shaping the breast with an implant, look up our article: Tailoring the shape of the breast with an implant. It is located on our blog on our website. Unfortunately, we cannot put links directly on these responses.
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.