Considering either implant removal or revision. Is it feasible to get smaller implants with more upper pole fullness? (Photo)

I had implants out in about 9 years ago. They're saline and under the muscle (can't remember how many CC's). They look really sad. My questions are, 1. If I have them taken out, will I need a lift, and 2. If I were to have them taken out, is it feasible to get smaller implants with more upper pole fullness? I don't want large breasts, just perky and full (Victoria's Secret look). I don't care if they look fake.

Doctor Answers 6

Choose your surgeon wisely

Upper pole fullness comes from projection, not width.  Wide, flat, moderate profile implants will flatten your upper pole, not increase it.  What you are asking for is more projection and more surface area, which comes from high profile implants.  You need to look at the charts with your surgeon to determine what width, projection and volume will give you the optimum results based on your personal perception of the perfect breasts.  It is very challenging to achieve an increase in fullness with decrease in size.  

A lift is not necessary based on these photographs.  In fact, a lift after implants is moderately controversial for two reasons. First, when you perform a lift you are making everything tight and closing the wounds under tension. It you add the expansive forces of the implant at the same time, you are fighting against yourself. There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars. In the worst case, the wounds will open. So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant. Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure. Or a smaller implant than would be appropriate is used so as to decrease the expansive forces. Either way, you are compromising the aesthetic outcome. Often the outcome is so compromised that a second revision surgery is required. If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation. The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.

The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple). By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple. By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple. If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop. If the venous outflow stops, the arterial inflow is stopped. If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.

The right operation is capsulectomy (removal of the scar that surrounds the implants) with removal and replacement with new implants (if you want replacement).  The size you choose and the projection will depend on all of your goals taken into consideration with your measurements.  Your starting point is good, so you should be able to achieve an excellent outcome if you choose your surgeon carefully.  The skill with which the operation is performed combined with the right implant choice is what is going to make the difference for you.

Larger Implants with the Revision

Yes, it is possible to #increase your implant size with a #revision. However, the #pocket will need adjustment and a lift may be necessary; to better #support the new implant. Additionally, a mesh for further support may be helpful depending on the #implant size and skin #elasticity. 

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Implant Revision

Good afternoon!

I guess it is time for a tuneup- I would avoid the explantation/lift idea- it will leave you with little or no upper pole fullness.

Instead I would recommend a breast lift to tighten the skin and lift your nipple position, and a smaller implant to provide upper pole fullness.

Overall this is a fairly common situation to find yourself in after a decade or so, and really shouldn't be a problem to reach your goals!

I have attached a link to my breast augmentation revision photo page for your review- hope it helps!

Adding fat and new implant might be a good option

Thanks for your question and the photos. I would not encourage you to get a lift. I don't believe the scars are a good trade off for you. One option would be to add some fat to the upper pole and then replace the implant with a silicone gel. It will look and feel more natural. If you want a rounder look, then a High Profile implant might be the best. Review some pictures with your surgeon and have them explain your dimensions to you. There are plenty of Board Certified Plastic Surgeons who are ASAPS members in your area. you can use the Smart Beauty Guide to help locate one. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 84 reviews

Redo implants

Probably you want something you can't get without a lift.

Now, depending on what implants you have, you might be able to get wider implants (more upper pole fullness) with less projection. This might be less or more cc's than what you have now.

But that's where a good consult will help you...I hope that helps some!

Michael E. Decherd, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 52 reviews

Implant revision options

Replacing your implants with smaller ones will give less upper pole fullness and if you are happy with the size then there is no reason to replace them. You may consider a lift to improve nipple position on the breast mound, which could give you the look you want. More specific advice would need to be based on knowing the size and profile of your existing implants, breast measurements, and clarification of your goals.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 46 reviews

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.