Do I need a lift for implant exchange if I don't want to go bigger? (photos)

I have 20 yo 360cc round textured silicone implants under muscle nipple placement. Although still soft and intact, I've never loved the unnatural slope and the way they look in clothes. Also, I never wanted to be as big as DD. So with their age, it's time to replace. I've had 3 consults w board certified PSs, 2 who suggest they would replace thru nipple sub glandular silicone rounds. One who thinks its best to do a lollipop lift w silicone under muscle by imfram. fold. Goal is natural. Help

Doctor Answers 10

Breast Lift with Existing Implants May Restore Volume

The objective of a Breast Lift (#Mastopexy) is to improve the shape and position of the breast without reducing their size. It is used especially for breasts which sag or droop (#ptosis) as a result of aging, weight loss, pregnancy, or breastfeeding. However, many women report more satisfaction if an implant is used at the time of #mastopexy. The implants further shape their breasts, restoring superior fullness or volume which may be decreased over time.
In regards to implants alone, this is usually said to be mistake by patients reflecting back at the decision. Most breasts will look larger and more droopy with solely implants. They will sag more and sooner, due to the sudden and excess weight. At times it's possible for a “Snoopy” breast or double bubble to develop as a result.  A Breast Lift can also be done while having existing Breast Implants and can be used to correct #assymetry.
It is imperative you select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast augmentation. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Do I need a lift for implant exchange if I don't want to go bigger?

Although it would require a physical exam to be certain, I don't believe you require a breast lift, even if you choose a somewhat smaller implant.  A capsulotomy or capsulectomy should be able to correct the unnatural slope of the breast, and could be performed via either a peri-areolar or infra-mammary incision.  Best wishes, Dr. Lepore.  

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Its tough when everyone has a different opinion

and feel you can achieve your goals through simple downsizing of your implant in the same pocket with release of the inferior capsule to improve the roundness.  The smaller implant will eliminate the convex upper pole you have.  You do not need a lift and you do not need to change this to above the muscle.  I would employ the dual plane method when replacing your implant under the muscle.. why change pockets when it worked so well for you???

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Do I need a lift for implant exchange if I don't want to go bigger?

Thanks for your excellent question and photos.  I agree with others that your problem is that your implants are "unsettled" and need to be lowered and possibly reduced somewhat in size.  I would avoid an uplift but possibly keep the option of a future Benelli lift open if the contour and nipple positioning is less than optimal.  I would also keep the implants subpectoral but exchange to possibly smaller smooth silicone implants since with proper release and positioning you would retain the significant benefits of subpectoral (or dual plane) positioning.Good luck and best wishes, Jon A Perlman MD FACS  Certified, American Board of Plastic Surgery  Extreme Makeover Surgeon ABC TV Best of Los Angeles Award 2015, 2016  Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Do I need a lift for implant exchange if I don't want to go bigger?

Thank you for your question.  I am respectfully going to disagree with some of the previous answers and the surgeons you have seen.  First of all, you do not have a "double bubble" deformity.  What you have is , in fact , the opposite of a "double bubble".  In a "double bubble" the implant pocket extends below the natural fold under the breast so that you end up with a new fold below the old fold and a bulge from the implant in between them.  In your case it looks like the implant is sitting up higher than the fold and is probably held there by muscle that has not been released in order to allow the implant to settle down and fill out the lower pole of the breast.  If your textured implants have stuck in place like they are supposed to then that will ensure that they will never drop.  The fix for this is to release the lower portion of the pec muscle in order to allow the new implant to drop down and fill out the lower portion of your breast.  It may be necessary to separate some of the muscle from the lower part of the breast, creating a "dual plane" pocket in order to achieve an optimal shape.  If your breast is soft then that would mean that you do not have a capsular contracture and thus, in my opinion, a capsulectomy is not indicated.  I do no think there is a reason to switch the implant to a subglandular plane based on you photos.  Perhaps there is something about your physical examination that has led to that recommendation.  The implant to use would be a smooth surfaced round implant with a profile that would match your breast anatomy for the size you want.  Whether you use silicone gel or saline would depend on how much breast tissue you have and how large an implant you want.  I would not go back through the periareolar incision for two reasons.  One, I believe there is a higher risk of capsular contracture when using that incision, especially when placing the implant in the subglandular plane. Two, a rare complication of that incision is retraction of the scar, creating a contour deformity.  I believe the risk of that increases when reusing that incision site.  My preference would be the inframammary incision. I hope this helps you with your decision making process.

Lars Enevoldsen, MD
Modesto Plastic Surgeon
4.6 out of 5 stars 27 reviews

Do I need a lift for implant exchange if I don't want to go bigger?

Thank you for your question.You have high riding implants, but your nipple is full below your breast. I do not think that you would benefit from a breast lift. I would perform an implant replacement in a dual plane position (staying under the muscle), without a lift.A slightly smaller implant, with release of the pectoralis muscle should allow the implant to come down and fill out the lower pole of your breast. This will help the nipple appear more elevated and will remove some of the excess fullness in your upper pole. 

Austin Hayes, MD
Portland Plastic Surgeon
5.0 out of 5 stars 38 reviews

Do I need a lift for implant exchange if I don't want to go bigger?

Thank you for your question and photos. Your photos demonstrate excessive upper breast fullness, with slightly lowered nipple-areolar position. However, your nipple position is far above the fold. This position does not generally require a breast lift. Implant positioning directly impacts nipple position. I tell my patients that whichever way the implant goes...the nipple does the opposite. So, a high-riding implant tends to drive the nipple position lower, whereas a lower implant positioning tends to elevate the nipple. A somewhat smaller implant positioned lower in the pocket could be beneficial in your case. My preference is for submuscular placement. I hope that this is helpful.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 18 reviews

Do I need a lift for implant exchange if I don't want to go bigger?

My thoughts would lean towards an explant and capsulectomy, conversion to a dual plane and a similar sized new smooth silicone gel implant of the inspira SRM style. A lift is not necessary as you have no droop, the implant is being help too high whether by the capsule or more likely by an incomplete muscle loosening. Definitely go under the muscle and you will easily achieve the more natural upper pole shape you like. We see this frequently in patients with implants of your vintage. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast augmentation shape question

Hello and thank you for the question and photos. Based on this, your shape is based on the borders or outline of the capsule. Remember that the implant is round. When the breast doesn't have a round shape, there can be an implant rupture ( possible with 20 year old implants ) or more likely, a non round capsule. i would suggest a complete capsulectomy with implant exchange. I would suggest a smooth round under the muscle with an INFRAMAMMARY incision. the nipple incision has a higher capsular contracture rate. Second, I would NOT recommend a lift. Your profile shows good nipple position compared to your arm. The nipple in general should be approximately half the distance between your armpit and elbow crease. If you lift it further, you will have the problem of too high a nipple position and it may show outside a bra or low cut dress. Rather, the implant is sitting too high. that makes the nipple look low and makes the upper pole of the breast bulge out. Lower the pocket slightly ( too much and it will lead to a double bubble for sure ) and keep it about the same size. As always, it's best to be healthy, no smoking, and make sure any health concerns are managed by your primary care doctor. Best to you. 

Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 21 reviews

Breast lift with exchange

You have a classic double bubble deformity that will require a capsulectomy, implant exchange and lowering, and a breast lift. Best of luck

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 42 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.