What should I revise so that I achieve a more natural appearance? (photos)

Question

Please help! I had a breast augmentation and lift with a doctor that didn’t listen to anything I wanted. I wanted a natural look and for my cleavage to be close together.At the time I didn’t know that he pretty much uses High profile implants on most of his patients. He told me I had a BWD of 11.5 and that I was getting high profile. I told him I didn’t want high profile but in surgery he ended up doing high profile and sub fascial. I hate them. What would you recommend for a revision?

Gary M. Horndeski, MD · Answer

You will need implants with a lower profile and lateral plication and more medial dissection to give you more cleavage.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

First, your breasts sit somewhat apart and the bases cannot be moved to bring them closer. Your will always have a gap between your breasts unless you chose a crazy large size that is crammed in. Please do not do that!  I would suggest going down in profile which will give a little wider base to your implants. this will probably fit your frame better. You might need to go down some in size. I also suggest placing the implants behind the muscle for better upper breast fullness and more coverage of the implant to decrease the "ball" look.

Kenneth R. Francis, MD, FACS · Answer

Dear Eclectic,
As is usually the case on this forum, we have no preoperative photos with which to compare your results.  And, as I have stated on numerous occasions on this forum, a breast augmentation/mastopexy is one of the most challenging procedures in plastic surgery.  It brings the variables of two surgical procedures, breast augmentation and breast lift, to the table at the same time.  Whether you and your surgeon communicated effectively on your goals and options is only known between the two of you.  At any rate, your topless photo looks pretty darn good and very natural.  Could you achieve more cleavage with a wider based implant?  Probably.  Have a frank discussion with him/her.  You may learn something that you haven't considered.  Alternatively, she/he might offer a discounted wider based implant exchange.  Good luck!

Camille Cash, MD · Answer

I'm sorry you are unhappy with your breast augmentation.  For a more natural appearance you can downsize the implants, use a lower profile (moderate plus may help), and place the implants beneath the muscle.  Begin by visiting a board certified plastic surgeon near you.  You may want to review surgeons' websites to find before/after photos of the look you desire.  I've included a video I hope you find helpful.

Mats Hagstrom, MD (license on probation) · Answer

Breast augmentation outcomes are generally based on three variables.
When there’s a lift involved, there is a bit more complexity.
The three variables that determine the outcome of a breast augmentation are.1) The patients candidacy for the procedure.
Not everybody seeking breast documentation is an ideal candidate.
Variables that will alter candidacy include things like breast position on the chest wall, breast shape, and especially breast, divergence and droopiness.
The surgeon cannot move where your breast is on the chest wall.
If your breast sit far apart, then they’re going to sit far apart after implant augmentation.
Likewise, if someone has breast divergence, then the divergence is going to be amplified with the projection of the implants.
 Understanding your own candidacy for the procedure and this is going to inpact The outcome should ideally be discussed thoroughly during the consultation.
2) The second variable is implant selection in regards to size shape and type.
I generally prefer lower profile implants.
The profile is determined by the breast with diameter compared to the volume of the augmentation.
As a general statement, anytime, excessively large implants are used the chance of undesirable side effects, complications and need for revision surgery will go up.
3) The third variable is the surgeons ability to put the implant in the correct anatomic location.
Outcome problems, like implants, riding, high or implants bottom out are related to this variable.
Personally, I generally stare towards putting plants below the pectoralis muscle, but it’s not wrong to put the implant above the muscle.
There is no real pectoralis fascia to go below for this procedure.
If you look at anatomy pictures of the pectoralis muscle, you’ll see that there is no fascia on the central part of the muscle.
To make a quality assessment regarding the outcome of any plastic surgery procedure we need to see a complete set of proper before and after pictures.
Without knowing what you look like before surgery, we can’t really assess the outcome accurately.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.Adding a breast lift, add another layer of complexity to the procedure.
To get a quality assessment and better understanding of revision surgery options, I suggest having a few in person consultations with other plastic surgeons in your community.
It is important to recognize that the surgeon can’t move the breast on your chest wall.
If your breast don’t sit close together, then adding implants isn’t going to do that.
If the implant is not placed centrally on each breast than the breast will not be centered on the implant.
This may seem redundant and in someways it is.
If the breast don’t sit close to the midline, and you put the implants close to the midline then the breast, don’t sit correctly over the implants.
It’s really important to show accurate before, and after pictures to patients during the consultations of previous patients who had similar breast characteristics, so patients understand what the procedure can and cannot.
This is especially true for individuals who have variables that make them less than an ideal candidate for breast augmentation.
Best,
Mats Hagstrom MD

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