Natural appearing breast shape with revision augmentation
Unfortunately the most commonly used type of implants (high profile) and the most common type of placement ( submuscular/dual plane) cannot deliver the natural 'tear drop' effect or cleavage that you desire. Leaving the origination of the pectoralis major medially intact in submuscular placement ensures that the implant cannot be medial enough to look natural, and a flat plateau is left centrally. There are also big problems associated with anatomic implants placed in conventional planes( they work well in subfascial carefully designed pockets). This is why I use a very unique methof of breast augmentation that I call 'cold-subfascial augmantation.' the placement of the implants is not 'above the muscle' or subglandular, nor is it submuscular or dual plane. A very strong layer of connective tissue is meticulously and atraumatically dissected from the pectoralis major muscle and this tissue is used to shape and support a lower profile implant into a gentle tear drop shape. It is the surgical dissection and not the implant itself that gives shape to the breasts. The results sit like natural breasts and do not move like submuscular implants do with arm motion. The fascia also supports the implant giving it relative protection from gravity and aging.
All the best,
Rian A. Maercks M.D.
The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size. This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone and low/moderate/high profile), bra manufacturer variance in cup sizes, the degree of filling of the cup with breast tissue, and the subjective differences in patients perceptions of cup size.
Much of the final “look” achieved after breast augmentation surgery depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant.
3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may make a significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
Without an examination it is impossible to determine the best implant style, projection and size. There are many factors including chest wall diameter and skin quality are important.
If you had bottoming out, then you have to fix the side that bottomed out. I would not lower the other side. Also, I prefer smooth implants.
VIDEO (Click HERE) What Profile and Texture of Breast Implants to Chose?
As stated by Dr. Rand, I would avoid a larger implant which will have the tendency for recurrent bottoming out. I tend not to use textured implants due to their feel but they work well in thsi instance.
Textured implants and implant profiles
Moderate plus versus High profile is determined by how much projection (WOW FACTOR) you want and how wide your breast is. Your surgeon should measure the the width of the base of the breast. The implant should be no wider than the breast. You do not want the implant going beyond the breast on the side or in the middle. The goal is to have as much breast tissue cover the implant as possible to help prevent the visible or palpable folds and wrinkles. You can get larger volume with a high profile than with moderate or moderate plus; however the high profile may look round and projected.
Smooth versus textured: textured implants are thought to decrease capsular contracture. The downside with textured implants is more wrinkling and higher incidence of rupture and deflation. I have stopped using saline textured implants and use silicone textured implants only for revision surgery to treat capsular contracture.
Most of the times it is more desirable to raise the dropped side. This is called a capsulorrhaphy. I would be cautious to place a larger implant as this repair is very tenuous and it is common for the problem to reoccur. So in some instances it is desirable to go smaller and placement of textured implants may help keep the implant in place but this may be anecdotal.
Genrally the fix to bottoming out is to re-fix the fold back to where it should be. This can technically be done in a number of ways. I would be concerned with placing a larger implant under these circumstances. Ultimately, in order to give an answer that would be appropriate, the plastic surgeon would need to see the patient and review the records.
Fixing bottomed out breast implants
Most patients will wish to raise up the bottomed out implant rather than to drop the other one, but you will see each direction taken. Going with bigger implants is sometimes done to change the look or the amount of cleavage but this adds weight and increases the risks of further implant malpositions. Work closely with a doctor who has an extensive experience with breast sugery as this is not best handled by a rookie.