450cc Moderate Profile Over Muscle - Bad Choice? Do I Need Another Lift?

Thank you for the question.

I'm sorry to hear that you're disappointed with the results of surgery. Sounds like the surgeon  was trying to avoid mastopexy surgery  and selected the size of implant he/she felt necessary to “fill the skin envelope”.

Unfortunate is no easy way to determine what you will benefit from in the future. This will ultimately depend on your goals. Some general thoughts regarding breast  augmentation....

 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 I find the use of goal pictures to be 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.
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.

Plastic surgeons use the location of the nipple relative to you breast fold to determine if a lift is needed or not.  If the nipple is at or below the level of the fold when looking from a side view then a lift is usually recommended. Depending on the extent of skin laxity, lifts can be as minor as through a crescent around the nipple, to a more moderate "lollipop" to the most extreme "anchor" incision.  If the nipple lies above the fold then a lift is not needed. Based on the photographs above, a lift would not be advised with the current implants.  If smaller implants were replaced, then more sagging is likely to be visible and a lift may be needed.  Probably a crescent or lollipop. 

So, the real question is:  are you happy with your current size or do you want to go smaller?

In order to determine if there was a different or better option I would need to before photos along with these after photos.  There is rarely only one way to do things, so I suspect that using different implants would have resulted in more or different scarring.

That being said, you could certainly have smaller implants inserted now, but you would probably need to redo the lift.  That would mean redoing the lollipop portion but also possibly to add the horizontal limb (making it an anchor shaped).  Whether or not that's worth it at this point is something you'll have to discuss with your plastic surgeon.

Incidentally, although you didn't ask, I think it appears to be a nice result.  I cannot, of course, say more than what I can tell from these two photos, nor do I know what you wanted.  But in view of the surgery you went through it seems to be a nice result.

I hope that this helps, and good luck,

Dr. E