Going smaller with only 50cc. Motiva Ergonomix breast revision. Will it make any difference? (Photos)

Question

I had my breast augmentation surgery Jan 2018: Motiva Ergonomix 335cc, HP, 11,25 cm base, 4,6 cm projection on both sides. I am not satisfied with the result, because hey feel and look fake to me, the projection is too high and they are to wide apart from each other. During last consultation my surgeon suggested going with Motiva Ergonomix 285 cc,11,25 base mid profile, but I am not sure that he understands what I aim for. What would you suggest for as natural look as possible for my frame?

Larry S. Nichter, MD, MS, FACS · Answer

First of all 50 cc's in volume is three tablespoon plus one teaspoon (less than 2 shot glasses). Figuring out how much of a difference this will make has to take account of several factors. 
A 335 cc implant will result in a variety of cup sizes based on existing breast tissue, width of your breast, rib cage shape and a number of other factors. It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 50 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 335 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in a bit.
Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors. For more than 25 years, I have tried just about every method to best understand and achieve the patient’s optimal goal. The following is what I have found to be most accurate: To start with, I have found it most helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. This gives me detailed standardized views and information both qualitative (shape, perkiness) and qualitative (size) and allows me to discuss with my patients how I can best achieve their objectives as well as realistic expectations. For example, though I always tell my patients that I cannot make them exactly the same as a photo because everyone has different anatomical constraints. However, these ”ideal” breast photos are brought to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to best achieve their wishes. Even if the photo does not match their height or weight, I and most plastic surgeons are very good at translating the proportionality of the photo to your features.
I personally order more than one set of implant sizes and use sterile implant “sizers” (temporary implants) placed in the created implant pocket during surgery to know in advance exactly which implant would work best for you in both a sitting and lying down position. This also allows me the opportunity to modify the pocket to meet some of the more subtle shape features desired. This enables me to use my full artistic potential to achieve your desired goals.
Larry S. Nichter, MD, MS, FACS

Daniel Barrett, MD · Answer

Dear 875gla0O1,it is unlikely that 50cc will make any significant difference. 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, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Daniel Del Vecchio, MD · Answer

The implant sized 50cc reduction  will not help alleviate your complaints of not looking natural ... if you had more soft tissue to cover the implants the cleavage gap could be treated and your breasts would look more natural.  This is called composite breast augmentation- using implants and fat.  We first described this technique in 2013 and it is a great procedure to make implants look more natural.   I have attached a link to the original paper we published with the technique.It’s so good, in fact, that the company that makes Motiva implants decided to copy and commercialize our our operation  and re-named it “motiva hybrid”, “from concept to standard”.  Best of luck!Dr DelVecchio

Don Fontana, MD · Answer

I would not be too critical of your result.  Although there is some asymmetry, you did exhibit this preoperatively. It is more difficult to achieve a perfectly natural appearance in patients who are very slender with little breast tissue than with patients having more breast tissue. The implants must be centered directly below the nipple, so that positioning the implants closer together would result in the nipples being malpositioned. If size is an issue, reduce the  volume of your present implants by 25-30%.  Talk to your PS to convey your wishes.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Dear 875,Hello and thank you for your excellent question. Breast implant sizing is a combination of current versus desired breast size, chest wall and breast measurements, and skin and subcutaneous tissue quality. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!
  
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon
  
Texas “Top Doc” 2017, 2018
  
RealSelf100
  
America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018
  
BeautyAdvisor Top Contributor

Going smaller with only 50cc. Motiva Ergonomix breast revision. Will it make any difference? (Photos)

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