Is pocket tightening necessary when downsizing from Motiva Ergonomix Full 350/380cc to Mini 230cc?

Question

Is pocket tightening necessary when downsizing from Motiva Ergonomix Full 350/380cc to Mini 230cc? I am 7 months post-op from a primary breast augmentation with Motiva Ergonomix Full implants (350cc left, 380cc right) placed in a dual-plane pocket. I quickly realized that the projection is too much for my frame, and I would like a much more natural result with minimal upper pole fullness. I am considering exchanging them for Motiva Ergonomix Mini 230cc implants bilaterally. During my consultation, my surgeon discussed two options: performing pocket tightening (capsulorrhaphy) at the time of implant exchange, or simply exchanging the implants and allowing the pocket and muscle to contract naturally, understanding that pocket tightening could be done later if needed. I currently do not have any obvious implant malposition, bottoming out, or asymmetry. My goal is simply to achieve a smaller, less projected, more natural appearance. How important is pocket tightening when downsizing by this amount? Is it reasonable to avoid it initially and see how the tissues adapt, or is it generally recommended to perform capsulorrhaphy at the same time to minimize the risk of implant malposition or bottoming out?

John LoMonaco, MD, FACS · Answer

The answer depends on the findings at surgery, but I would prepare you for doing it.  You have a bit of contacture or tightening to my eye on one side, which pushes the implant higher.  Do you see that ?

This might mean some capusle work (release and re-sewing) is needed.

With a smaller implant, your risk of bottoming out is low so I wouldn't do a capsule repair just for that reason.  Once the new implant (or a temporary sizer) is placed in suregry, Id sit you up, see if I like the way the implants"sit" in their new pockets, and adjust accordingly.

Yasemin Aydinli, MD · Answer

Thank you for such a detailed and well-researched question. Before I answer the pocket-tightening question directly, I want to share what I see when I actually measure your breasts on the photos you provided &mdash; particularly the side view &mdash; because I think it reframes the whole plan.
In aesthetic breast analysis, the most cited work on proportions (Mallucci and Branford, "Analysis of the Ideal Breast") describes the ideal breast as having an upper-pole-to-lower-pole ratio of about 45:55 &mdash; meaning roughly 45% of the breast sits above the nipple and 55% below &mdash; with the nipple angled slightly upward (around 20 degrees), a straight or gently concave upper pole, and a full, convex lower pole. When I measure your breasts against this standard, your proportions come out essentially reversed: your upper pole is over-full, closer to a 55:45 ratio, and your nipple points downward and sits below the point of maximum projection. In plain terms, your upper pole looks unusually full and high, while your own tissue and nipple hang below it.
This is the key point: your main problem is not that your implant is too large &mdash; it is that the implant is sitting too high on your chest. That high position is what creates the oddly full upper pole and the waterfall pattern, and simply downsizing the volume will not correct it. In fact, it could make it look more obvious, because reducing projection removes some of the fullness that is currently filling the lower breast.
It also matters for how a smaller implant would behave. Motiva Ergonomix implants are very soft and smooth, and one known consideration with them is a tendency for the pocket to stretch and widen over time. If we place a much smaller 230cc implant into your current pocket &mdash; which is high and relatively wide and open &mdash; the smaller implant will have too much room and will move around, and can ride even higher or shift to the side. So in your case, pocket work is not optional: the upper and outer (lateral) parts of the pocket need to be tightened to control where the implant sits, and the pocket should be reshaped to bring the implant down into the correct position.
So, to answer you directly: downsizing is reasonable if you simply want less projection, but it will not solve your real issue. The real issue is the high implant position and the reversed proportions, so the plan should focus on lowering and tightening the pocket (superior and lateral capsulorrhaphy) and bringing your nipple and lower pole back into balance &mdash; so that a new, correctly positioned implant gives you proportions closer to that ideal 45:55 with an upward-pointing nipple. The precise plan is best confirmed with an in-person exam and measurements.

Is pocket tightening necessary when downsizing from Motiva Ergonomix Full 350/380cc to Mini 230cc?

Answers (2)

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