How Would You Plan my Augmentation? (photo)

I have saline implants placed 3 years since then I've had a pregnancy and nursed afterword. My implants have bottomed out and I also do not like the firm unnatural feel of the saline. What would you reccomend I do to correct these issues? I have attached pictures of my breasts and the breasts I'd like to have. Costs?

Doctor Answers 6

Implant Exchange, Plication and Simultaneous Lift

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The first thing I would do is remove your saline implants through a circumareola approach.  You would need your implants placed retro-pectoral, if they are not there now, and you will need plication laterally and inferiorly to raise the new implants.  I also suggest smaller sized silicone gel implants.  At the same time, I would reshape your existing breast issue, elevate it higher on the chest wall and more medial to increase your cleavage.  All this can be done through a circumareola approach avoiding the ugly vertical scars of the lollipop or boat anchor shaped incisions.  It is possible to achieve the results comparable to the photographs you have shown using this technique.  The cost would be approximately $10,000.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Revision augmentation and lift

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First, you would need a revision of your lift to correct your gladular/implant ptosis.  You mighe consider a larger impalnts to improve the upper pole fullness as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bottoming out repair

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I would perform a slightly larger implant, using a textured silicone implant.  I would perform tightening of the lower pole using the excess skin as a sling to the muscle (similar to the use of ADMs without having to buy an ADM although I do think that ADMs are better and hold things in place longer if cost is not an object), and suturing the skin tight down to your fold.   Good luck 

Christopher Park, MD
Mobile Plastic Surgeon
4.7 out of 5 stars 9 reviews

How would you plan my augmentation revision?

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Thanks for providing photos.  It appears from these that:

  1. You have a fairly long distance from the nipple to the fold
  2. Your breasts have stretched a fair amount within the lower pole

To address your concerns and to achieve results similar to the photos you provided, you may want to consider the following:

  1. Bilateral conversion from saline to silicone gel implants
  2. Moderate upsizing of the implant volume (approx. 100 cc)
  3. Revision of your breast lift with a focus on reducing the distance from the nipple to the fold so that your breasts look less stretched out and more youthful 

In revising your breasts, keep in mind that the more weight you add to them, the faster they will droop.  And so trying to achieve a result like the first picture may not be the best best in the long run.  Instead, I would go for a more conservative upsizing as demonstrated in your second set of photos.  Breasts droop over time as a result of changes not only to the skin but also to the internal Cooper's Ligaments.  And so when this happens, we can replace lost volume with an implant and tighten the surrounding skin envelope but there is nothing we can do to tighten these ligaments.  That is why a much larger implant may not be the best choice.  It will look good in the short run but, in the long run, your breasts will simply stretch over time back to their original appearance.  


I hope that helps!


How Would You Plan my Augmentation?

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1.  Switch out to silicone.

2.  Redo the breast lift. The nipple-areolar position is OK, but the implant has descended within the breast tissue. A horizontal incision in the fold is needed. The "excess" tissue can be used to reinforce the strength of the support given by the breast tissue. But using an ADM (acellular dermal matrix) would be a consideration to provide better support.

3. Although you don't mention size, going larger would increase the chances of the current problem recurring.  The same size implant properly positioned by the breast lift should restore your fullness in the upper pole.

Thanks for your question, all the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Correction of bottomed out implants after pregnancy

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While no one can give you specific advice without seeing you personally, it appears the the implants have dropped (bottomed out.) There are several things to consider, depending on your specific situation. One is switching to silicone gel implants, which might feel better. The pocket that hold the implants would be revised to raise the position of the implants. If the tissues of the lower breast area weak or thin, then reinforcement of this might be needed. The best way to do that would be with Strattice, which would add coverage and support sort of like an internal bra.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 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.