Questions about downsizing, profiles, and lifts (picture included)

I am 5'2, 108 pounds, and have a 27" ribcage. I had my first breast surgery about 2 and a half months ago. I am looking to downsize but am unsure on whether to change profiles. Currently, I have 425cc Natrelle style 20 silicone HPs under the muscle. I was a deflated and very saggy C-cup before surgery and wanted to end up in the full C to small D range. I was recommended "no less than 400cc" by my doctor. I am now sizing out much larger and want a revision (250 - 325cc). I also had a full anchor lift. I feel as though I have the terrible scars without the actual benefit of lifted perky breasts. It was explained to me that a high profile implant would mean more upper fullness, which I lost after breastfeeding my children. Instead, the high profiles look like they hang low without providing fullness to upper chest.  Also, my asymmery is still present. My right breast is noticeably larger and the areolas are large and more uneven than before. All these issues were discussed with my doctor before surgery but were not adequately addressed. I am very unhappy and disappointed with my result, and I'm left needing the same things I did before surgery (lift, smaller areolas, improved symmetry). Which implant size and profile would better suit my petite frame? Can the implants be positioned higher, or is it a matter of changing to smaller implants that'll help with the positioning? Due to the submuscular placement, would I need pocket/muscle revision for smaller implants? Would I need a minor or full lift? How long do I need to wait before I can have my areolas reduced without serious risks? Another problem is that I have very visible rippling. Would a lower profile mean even more rippling? My doctor is now recommending Natrelle style 45 because it's the highest profile, which is supposed to cause less rippling, but I fear it will make matters worse.

Doctor Answers 9

Breast Revision to Include Smaller Implants

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It is definitely possible to #downsize to smaller implants and also alter the positioning; if possible. However, decreasing is size may also require a Breast #Lift to to #tighten loose skin, better optimize the end result. Any #revision has risks of unhappy outcome or other complications. #BreastAugmentation without a #BreastLift is usually a mistake looked back on by many patients. Most breasts will look larger and more droopy.They will sag more and sooner because of the excess weight altering the longevity of the results. The shape will usually not be satisfactory and sometimes results with “Snoopy” breast or double bubble. .A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is the most suitable for #breasts which sag or droop (ptosis) as a result of development, aging, pregnancy, breast-feeding and weight loss . Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy.
With both implant types there are choices when it comes to size, shape, and profile. The criteria best to suit you will be discussed in full detail at your breast augmentation consultation. Also, the right implant for the revision is contingent on shape of body and your desired outcome. Altogether, the surgery will create an elevated, more youthful breast contour. Also, the nipple and areolae of the desired size and correct heightmay also be addressed. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon. 

Breast implants and revisionary surgery

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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" 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 press 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.

Disappointing breast lift and implant

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I agree that your current result looks poor to me.  There are many factors that contribute to such a result including but not limited to the patient's own tissues and elasticity, the skill of the surgeon, the choice of procedure and implant, and the healing of mother nature and scar tissues.  You will not get better with time in the current result unfortunately in my opinion.  You will likely do better with a smaller implant, not a bigger one, placed under the muscle and with the entire lift re-done with more of the excess skin taken out.  Good luck!

Breast Implant Revision

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Based on your pictures, it appears that you would greatly benefit from a submuscular (under the muscle) silicone implant with a mastopexy at the same time.  This should give you a much more natural result.  With such large implants like you have now and poor skin quality, it is difficult to achieve a natural result without downsizing the implants and redoing the lift.


Good Luck.

Breast issues

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Thanks for the photos!  Certainly going smaller can be achieved, and with this, the areola can be made smaller and the envelope tightened a bit. As for the right impalnt for you, it depends upon your exam and goals.

Too large implants, small chest and ptosis

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You have a combination of complex problems now. The implants are too large for your chest. Even though you had a lift, the breast tissue stretched out and it appears that the quality of the skin is poor. Smaller implants would solve the size problem. You will still have to deal with skin quality and ptosis. My recommendation is have the implants exchanged to a 300 to 330 cc moderate profile silicone implants, wait a few months to allow the pocket and the stretched out skin to settle and get a lift. Good luck

Raj Chowdary, MD (retired)
Allentown Plastic Surgeon

Breast lift procedures improve breast shape

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I would consider using a small implant and revising your anchor-pattern breast lift around this smaller volume. Wait several months before attempting this revision. You may need some breast tissue removed to accomplish this revision.

A full lift and smaller implants

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Sorry for your unhappy result.  It appears as if your implants are too large for your small frame. I think that you need to have your mastopexy redone, possibly tighten your capsule on the inside ( capsuloraphy), both to make a snugger pocket for a smaller implant.  It is hard to tell in pictures, but somewhere in the 275 to 300 range with a moderate to moderate + implant would look good.  Sometimes, however when people have poor elasticity in their skin lift procedures will stretch out quickly.  Using smaller implants I think would give you a nice result and hold up longer.

Good Luck,

Dr T

Revision Augmentation-Mastopexy

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Your issue, like many other patients, is complex and can be answered through a number of different techniques by different plastic surgeons. Importantly, in my opinion, the Style 45 is not an option. I've now personally removed these implants from three patients in which they already demonstrated (through several months) an irreversible depression in their rib cages. While high profile implants can help with rippling, if you have a large base width and stretched out tissue from previous surgery or through the process, unless you stay with a large implant, there often is no discernable difference in rippling. It's obvious that the diametersof your areolas need to be reduced and your entire breast skin flap can be tightened with a smaller implant to accomplish your goal. One advatnage is that you already have all the necessary scars to provide you the improvement you need. If your surgeon simply exchanged your implants, did not alter your capsule, nor tightened it through either removing it or placing permanent sutures in it, and just excised some skin, then the result is often one that your are experiencing now. Rather than dictating the size of the implant, focus on the cup size, and leave your surgeon with enough flexibility to accomplish your goals. I would wait a minimum of 6 months considering that you've had several surgeries before proceeding with the next. See the below pictures of a similar example patient in which the implant was downsized 50% with a very good result. Hope that is helpful.

Jeffrey D. Hoefflin, MD
Los Angeles Plastic Surgeon

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.