Can my right breast implant be exchanged for a smaller implant without loose skin?

    The smallest conceivable volume at which a cup size increase is realized is 150 cc.  30 cc is not a noticeable difference.  At 4 weeks, there may be some swelling left and there may be some change during healing.  Kenneth Hughes, MD breast implants Los Angeles, CA

Hi, I understand your frustration. After surgery, one breast can swell more than the other temporarily. It is too soon to judge whether they will be the same size. After at least 4 months, you will have a better idea how symmetric  your breasts are. All women start out with differences in the size and position of the breast and even differences in the shape of the bones underneath the breast. In surgery, I sit patients up to assure they are as symmetrical as possible.

First thing is don't panic! It's very early to make judge. PIP implants had a different gel from your new implants as well as different dimensions and it may not simply be a matter of size. Sometimes in mild asymmetry one might use symmetrical implants and usually 20 to 30 g is not a very significant change in size. I suspect the best plan is to let everything settle down then reassess the situation with your surgeon, looking at the differences and how this might relate to the implant choice. A change of 30g or so would rarely give rise to loose skin (though may make little difference to the overall size of the breast).

Simply looking at the mass (grams) or volume (cc's) isn't enough to understand what's going on. Your surgeon is also considering the dimensions. Here are the numbers:

PIP 245 cc:        11.7 cm diameter, 3.0 cm projection

PIP 265 cc:        12.4 cm diameter, 3.1 cm projection 

Natrelle 255 gm: 10.0 cm diameter, 4.8 cm projection

Natrelle 285 gm: 10.5 cm diameter, 5.0 cm projection

 

Rather than evaluating only size, your surgeon must consider projection, diameter and size.

 

Projection:

Your Natrelle implants project much more than your PIPs. Also notice your 2 PIP implants only differered in projection by 1 mm (negligible) from each other. So the 12.7 mm (half an inch) difference in projection you now notice is not due to incorrect implant sizes. Also notice that using the 2 different Natrelle implants would give a 2 mm difference rather than the 1 mm difference your PIPs had. So there's no way to directly convert the PIP projection to Natrelle projection.

 

Diameter:

Your new Natrelle impants are significantly smaller in diameter than your PIPs once again making it impossible to correlate the PIP diameter to Natrelle diameter. Furthermore, the difference between the 2 PIP's is 7 mm while the difference between the 2 Natrelle's is only 5 mm - again no correlation and negligible.

 

Size:

As you know the PIP size is measured in mass (grams) while the Natrelle is measured in volume (cc's) once again making direct correlation impossible. Furthermore, the difference between the 2  PIP implants is 7.5% while the difference between the 2 Natrelle implants is 10.5% - a much larger difference. Your surgeon probably could not justify placing 10.5% different sized implants based on your amount of preoperative asymmetry. Perhaps if Natrelle made 2 implants different by 7.5% (like your PIPs), he would have offered to use them.

 

By looking at all the numbers, you can see that placing different sized Natrelle implants may not have prevented you from having asymmetry right now. Your surgeon took into account your original PIP sizes, your dimensions and sizes 3 months after the PIPs were removed, and the implants available to him.

 

Furthermore, your breasts need time to accommodate to the new implants which are smaller in diameter, higher in projection, and slightly larger in size compared to the old implants. It will take time. I would wait at least a year before reevaluating the size and considering changing one of them. At that time, you and your surgeon will be able to make a much better determination of what size and dimension implants will be best.

 

You've been through a lot. Having asymmetrical breasts treated with PIP implants left you with 2 problems: dangerous implants and the need for more surgery. Fortunately, you no longer have dangerous implants inside your body - that's something to be happy about rather depressed and crying. You also can be happy that you're breasts have been enhanced to a size larger than your natural breasts like you wanted with safe implants - that's also something to be happy about. Unfortunately, you may have to wait before everything is as good as possible. 

 

 

 

I can understand your frustration. Your question about loose skin is a good one. If you have reasonable good skin elasticity and change to a slightly smaller implant, you probably will not have a problem with loose skin. 20 mL is probably not enough of a difference to stretch out most women's skin significantly or beyond its ability to contract. Obviously, this is impossible to predict with absolute certainty, though.

With regard to your asymmetry issue, I recommend not rushing to make any changes. You are still early out from your procedure and things are still healing. That being said, it is impossible for any of us to determine the best course of action over the internet. Discuss your concerns with your plastic surgeon. It is really important to communicate your dissatisfaction so that he or she can evaluate you and determine the best way  to proceed. If you feel like you would like a second opinion, set up a consultation with another board certified plastic surgeon. 

You will feel much better if you have a clear set of recommendations and a treatment plan for moving forward from a plastic surgeon. I wish you the best!

 

Michael Vennemeyer, MD