Low vs moderate plus to go smaller? Implant replacement help

Dear blondie2021,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

The technique I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

From the posted photos it does appear that smaller implants will be more harmonious with your frame. Without having more information it's difficult to recommend a specific volume, however a moderate or moderate plus implant will give you a little more projection and shape.

I don't know what size you now have, but do agree that the implants are too large for your tissue. I am not a fan of the low profile since they are flat and wide. I vote for the second surgeon's selection.

Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Without knowing what your current implant size is it’s hard to give you feedback in regards to what size may be appropriate.
My personal preference regarding implant size and type is to work with before and after pictures to get an idea of what the patient is hoping to achieve.
During surgery, I use temporary sizers to determine what size and shape implant will give an outcome, consistent with the desired Results the patient demonstrated by reviewing lots of before and after pictures.
I bring those pictures with me to the operating room.
I have a full selection of implants at my disposal and select the implants based on using sizers that help me determine what size implant will get the right look.
Both surgeons agree you need a lift and I think everybody else does as well. Most plastic surgeons who have extensive breast surgery experience will prefer subdural augmentation. A lot depends on your current implant position and how your first operation was performed.
The degree of projection is usually based on a relationship between the total volume being used and the diameter of the breast.
Low profile implants, generally look more natural, but to maintain a certain volume sometimes surgeons need to increase the profile to have the implant fit in the natural breast diameter.
There’s no way we can help you pick providers.
Pick the provider you feel more comfortable with and go with their recommendations.
Provider selection is a complex process and choosing the right plastic surgeon is not easy or straightforward.
Most patients in the end are not very good at selecting plastic surgeons.
I generally recommend patients select providers by first making a list of local plastic surgeons who seem to have extensive experience in the procedure you’re interested in.For example, those seeking cosmetic breast surgery may want to look up who does most of the breast cancer reconstruction in your area.
Surgeons do a lot of breast cancer reconstruction tend to be overall good at breast surgery.
Next, I recommend scheduling in person consultations exclusively with each of the providers on the list.
I generally recommend people avoid virtual consultations and always schedule in person consultations.
Bring pictures of your body to use as reference during each consultation.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics to your own.
Hopefully your providers will have done lots of previous cases that were fairly similar to what you look like and what your needs are.
Take careful notes regarding both the quantity and quality of before and after pictures.
Being shown in a handful of pre-selected images representing only the best results of a provider career or of patients whose candidacy for surgery were different than your own, may not be sufficient to get a clear understanding of what average results look like in the hands of each provider.
Seeing limited results may also not be sufficient to get a clear understanding of what your results will look like or how many of these procedures that surgeon has actually done.
Most people don’t have a lot of experience consulting with plastic surgeons.
The more consultations you schedule the better you’ll be as a consumer at vetting plastic surgeons, and going through the consultation process.
From the information you’ve put forward, there is very little difference in the approach of the two surgeons.
In reality, one may be substantially better than the other, but from the information provided we can’t really tell you one is better than the other.
Assessing a plastic surgeons skill and experience requires being a shrewd consumer and asking correct questions and pushing providers to really expose what they have available in regards to before and after pictures.
Insist on seeing a certain number of results.
If the surgeon starts making excuses why they don’t have more pictures than you’re not in the hands of the right surgeon.
Sometimes you have to go by your gut instinct, and sometimes you need factual information that confirm someone has to skill an experience to do the job correctly.
To assess your candidacy for surgery, we would need to know a lot more about your previous operations.
Whenever somebody is seeking secondary surgery, they should generally come to consultations prepared, bringing with them complete sets of before, and after pictures of preview procedure, operative reports or generally the entire medical record from their previous providers.
Good luck,
Mats Hagstrom MD