Is This Overly Cautious: Breast Augmentation? (photo)

I had a BA & TT done 5 months ago. Overall he did beautifully, however, the upper region of my breast is still not full. When I asked about a revision he said he didn't believe I could handle bigger. BW is 12in. was an A; now a B. I250 mod prof plus on left & 300 high profile on right (to correct asymetery: prolapsed rib cage). Would the Natrell be a better option to suit my narrow width &allow more upper fullness? Is textured really better for my case? Is his concern for sag in 1-2 years legit?

Doctor Answers 10

Larger breast implants for upper pole fullness

I agree that overall its a good result. If you want more fullness in the upper pole, I think you can definitely place a larger implant. If you are going to go larger, I would suggest at least 100cc per side to make it worthwhile. Without measuring you myself, I cant really give an opinion on HP or moderate plus. I would suggest a larger implant rather than fat grafting.

Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Chest Wall Asymmetry and Breast Implants

I think the answer here pertains not to breast implant size or shape, but as to your chest wall.  The implants in your immediate post op photo are close together;  the longer term photograph demonstrates them to be even closer. In patients with a pectus deformity (depressed breastbone) there is a tendency for the implants to move towards the center. Fat grafting in the upper pole can work well as the fat will stay where it is placed, whereas implants can move overtime. I think your size determining feature may be rib position more than breast width or size asymmetry.  I would wait to make certain that your implant position is stable before embarking on any revisionary surgery. 

Ronald A. Lohner, MD
Philadelphia Plastic Surgeon
4.7 out of 5 stars 20 reviews

Upper pole can be improved with fat

If your desire is to have more fullness just in the upper pole then you may be a candidate for fat grafting. I don't like the HP implants in standard augmentation because of their round shape and tendency to cause impression into the chest wall. Another option would be to consider a shaped textured Sientra implant. I would be careful about doing too much though. It appears on your pictures that you have a great result. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 90 reviews

Is This Overly Cautious: Breast Augmentation?

Very hard to evaluate via posited photos. But might guess is a right donut lift, exchange to UHP silicones of different sizes, plus fat grafts for fine tuning. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

High profile breast implants to increase size

While not suitable for everyone, in general the use of a high-profile breast implant that matches the breast base diameter is the largest size that should be used. It isn't as natural of a look however. Textured implants will probably not make a difference.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Consider higher profile implants


Thank you for the question and the photos.  You may want to discuss higher profile implants.  You can maintain your current breast implant width and just increase the projection of the implant.  Instead of moderate profile plus and high profile you can consider high profile and extra high prolfile (Allergan 20 and 45 style implants respectively).  In addition, I think your breasts have a little more room laterally (on the side) to allow for fullness, thefore a slightly wider implant can take more space laterally without any additinoal space taken up medially (toward the cleavage).  Fat grafting to the upper pole is also an option.  Textured versus smooth is not that really a key issue for you.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

Improvement seems possible

It seems unfair for us to comment on your surgeon's work, as we cannot see you in person.  However, I think you can likely get an improved result.  It is difficult in your photos to see the rib cage issues, and sometimes a person has to choose between shape and size or symmetry.  In other words, we can often achieve a similar volume on both sides which will give you an even look with your clothes, but will not necessarily give you a mirror image on each side when you are not clothed.  This may be true if you have a significant asymmetry between the 2 sides.  

I don't think textured is really better, and I think you may be able to increase your size, but a full in person consult is best with a board certified plastic surgeon, preferably a member of the American Society of Aesthetic Plastic Surgery.

Good luck!

Roxanne Sylora, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 18 reviews

More Upper Fullness after Breast Augmentation

Based on your pictures, I would not suggest larger implants as I don't think there is room on your chest for wider implants. Ask your surgeon if fat grafts to the upper breast would be appropriate to give you more fullness.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 68 reviews

Overly Conservative Breast Augmentation

    For a woman with a 12 cm chest wall width a patient can get more than 300 cc.  However, it is important to remember that different people have different views on aesthetics.  In my practice, if the implant can fit the chest wall dimensions I will perform the breast augmentation for the patient.  For instance, there are patients in whom I will place 700 or 800 cc implants in a primary augmentation.  However, other plastic surgeons may place implants up to only 450 to 500 cc.   

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Larger implants.

Based upon the 12 cm (I imagine, not inches), but not based on examination, you could certainly tolerate HP implants as large as 425 cc using Natrelle implants. I am not a big fan of textured implants, and rarely use them, and I am not sure why your surgeon preferred them in you. 

No comment on the difference of 100 cc on sag. I don't think you can know for sure. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

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.