Advice on reducing upper pole for more natural appearance? (Photos)

Question

Looking to reduce upper pole in the one side as it looks too full compared to the other, implant sizes are 275 and 425 Thinking of reducing 425 to 325 for more of a symmetrical look as asymmetry was overcompensated for with first surgery

Mert Demirel, MD · Answer

Reducing the 425 cc implant to around 325 cc may be a reasonable way to soften the overfilled upper pole and make the breasts look more balanced. A 150 cc difference between implants is quite large, so it is possible that the first surgery overcorrected the natural asymmetry.
That said, implant size alone may not solve everything. Upper pole fullness can also be affected by implant profile, pocket position, muscle tightness, capsule, and how much natural breast tissue each side has. The surgeon should evaluate whether the fuller side needs only a smaller implant or also pocket adjustment.
In cases like this, a “chestnut” type approach can be helpful: instead of chasing perfect symmetry with a very large implant difference, the goal is to reshape and balance the breast footprint more naturally. This may involve choosing a more moderate implant size, controlling the pocket, and allowing the breast to sit in a softer, less over-projected position.
If the larger side is too high, too full, or too tight, simply downsizing may not be enough unless the pocket is also adjusted. If the nipple position or lower pole differs, a small lift adjustment may also be needed for symmetry.
My advice would be to ask your surgeon to compare both breasts separately: implant size, base width, profile, pocket height, and nipple-to-fold distance. Reducing the 425 cc implant may improve the upper pole, but the best long-term result usually comes from balancing the implant and the pocket, not just changing the cc number.

Wayne I. Yamahata, MD · Answer

As implant volume is increased, the upper poles fullness is increased as well. A physical examination by your surgeon can rule out other causative factors such as capsular contracture. At that point you can discuss options, including placing a smaller implant on the side with greater upper pole fullness. .

Kelly Schultz, MD · Answer

Based on your photos, I agree that your left breast appears fuller and wider than the right, and it does seem that the asymmetry may have been overcorrected with a larger implant. Downsizing the larger implant would likely create a more balanced, symmetric appearance.
That said, the exact implant size is best determined during an in-person consultation. Your plastic surgeon will evaluate your implant position, assess your soft tissue, and take measurements such as your breast width and tissue characteristics to determine the most appropriate implant for each side. In some cases, simply exchanging the implant is sufficient, while in others, small adjustments to the implant pocket may also help optimize symmetry.
I would recommend meeting with a board-certified or board-eligible plastic surgeon who can evaluate you in person and discuss the best approach based on your anatomy and goals!

Laura Roider, MD · Answer

Thank you for including a photo. It helps me provide recommendations 
While it is clear that your implants are two different sizes, the cause of the increased upper pole on the one side could be a few things such as, difference in implant size/base width or capsular contracture. Additionally, how to address the asymmetry depends on the cause. 
If the increased upper pole is due to differences in implant size/width, downsizing and selecting an implant with a better match will improve the appearance. 
If you have capsule contracture on that side (which seems likely based on your photo), I would recommend implant exchange and capsulectomy.

Ramiro Morales, Jr., MD · Answer

Thank you for your question and picture.  That might be the correct new size of implant.  The best way to tell is to have your surgery use temporary sizers in a bra in the office ADDING SIZE to the smaller size until they both look equal.  Then the PS will have a better idea how much smaller to make the larger size.   And then, I would still use temporary sizers in the OR to be sure to get the closest symmetry possible.

Ronald J. Edelson, MD · Answer

It’s obvious that your implants are different sizes. Using different size implants is a game that’s hard to win.  You can let your surgeon try different size implants at the time of surgery to determine the best fit. Ultimately it may be best to use the same size on both sides

Mark Eberbach, MD · Answer

The answer is straight forward. The options are increase the smaller, reduce the larger, or do a combination. Your pre operative photos would help decide.

This is not as simple as it sounds since the skin envelope and base diameter is also asymmetrical. With a change to smaller the new implant will tend to slide and move more when lying down unless the pocket is also modified. This takes a lot of experience to get right but is not technically difficult.

An ultrasound may be needed prior to decision making.

Good luck.

Generally,

Advice on reducing upper pole for more natural appearance? (Photos)

Answers (7)

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