Could I swap out my moderate classic implants for high profile, or would they have to be too large for my frame to cover my bwd?

Question

I currently have a slight double bubble, and horrible hypertrophic scars. My surgery was a year ago. I am 5'5, 135 pounds, 29 years old, 14cm bwd, 34 inch ribcage. And I have moderate classic 470 ccs of implants. I would like less boob in my armpits, and more production-but in general, a more natural look. I would grratly appreciate any feedback on what my next implant should be. I feel like a matronly cience experiment right now. I'd appreciate any advice!

Alejandro Nogueira, MD · Answer

Your is a collection of reasons how not to make a breast augmentation. Here your problems and their technical correction:-your incision is not orthodox, it is not at the central sumammary fold, is somehow lateral, that is not correct, that is an exposed area of the side of the boob and the right location is straightly downwards the nipple below at the sumammary fold, there is no justification for this and, sadly, it has no correction, once the implants are changed for some of correct dimensions (yours are too wide, obviously) the new sumammary fold will be quite likely above this scar making the scar be on the chest and not on the breast-your implants, as forementioned, are too wide for your mammary base framework, you need narrower and shorter ones; because of this excess of width you have the bulge at the sides and at the bottom (too long distance nipple-submammary fold); therefore you need narrower implants but... -narrower implants when a too wide ones have previously inserted are a challenge; if you have implants wrongly chosen and too wide for your theoretcial 
mammary base, then you need to go for implants that are narrower to an 
exact fit into your ribcage, but this does not necessarily mean 
downsizing them, or changing the profile, the profile or projection can 
be the same, but with narrower base. If the reduction in base is 
slight or moderate no additional gesture is needed, but if the difference
 from previous base to current widht is significative like will be in your case then a lateral (to close the armpit pocket) and
 lower (to reduce the nipple-submammary fold distance) capsulorraphy in multipoint modality are bound, and yes... this 
is the MOST difficult maneouver in revision surgery of the breast, I 
tell you in my experience it catches more attention from my brain than 
any other procedures, but I can also tell you the results are awesome.-you also have a dynamic double bubble deformity that worsens into a grotesque shape when you contract your pectoralis muscle, this is because the surgeon used the partial submuscular location aka dual plane (a very good and brilliant option, no criticism about it) but he did NOT release the muscle from the cutaneous adherences, so this creates this double fold effect aggravated with contractionNeedless to say you need a very very good surgeon with very good skills and vast experience in revision cases and capsulorraphies. I recommend subascial plane and latest generation anatomical shaped, cohesive gel filled macrotextured implants (polyurethane if available, since they make biovelcro). What an amazing case for the right surgeon, a hell for many, beware who you choose, things may worsen if the technique is botched again.

Donald R. Revis Jr, MD · Answer

Good morning!It does appear you have a few things going on!You have some lateral bottoming out with a double bubble, which occurs when your pockets are too wide for your implants, allowing them to slide too far towards the sides. I correct this with the Internal Bra, my strong permanent internal suturing technique which corrects the bottoming out and provides excellent long term support for your implants. This will also help tuck in your crease scars back into the crease where they belong, which will make them much less visibleI would also switch you to either Mod Plus or High Profile implants in the 400-500cc range. Also your nipples are already widely spaced at the outer borders of your breasts- if you tighten up the lateral part of the pockets to get them out from under your armpits, the nipple position will tend to rotate even more laterally, so to prevent this I would recommend a donut mastopexy, which would allow me to move your nipple position more medially and keep them centered on your breasts. I have attached a link to my Internal Bra breast revision photo gallery for your review- hope it helps!

Steven Wallach, MD · Answer

An implant exchange is possible. It would be best to see you in person to determine what would be best for you. It is impossible to say without the exam.

Robert Whitfield, MD · Answer

Yes you can have an exchange with a new pocket on each side.  The implant choice would typically be more narrow to complement your frame.  We would definitely want to minimize scarring for you.

Paul Izenberg, MD (retired) · Answer

There are a number of issues here and an exam by an experience breast surgeon is mandatory to determine exactly what needs to be done. But the implant pocket appears to need modification laterally and inferiorly to narrow and lift the implant to correct the "double bubble". Implant exchange probably would help with a narrower base and a little more projection. I certainly would not recommend anymore volume for your frame at all. Once the pocket is closed you might need less.  By lifting the fold, the incision should be more hidden even if a revision results in less redness and hypertrophy.

Could I swap out my moderate classic implants for high profile, or would they have to be too large for my frame to cover my bwd?

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