Tennis Ball Look! Can I Decrease Implant Size and Look More Natural?

I have Perthese implants 350cc moderate profile (13 cm wide, 4,2 cm projection - I had the surgery done in Sweden. I feel that they are two wide and have too much volume. My breast with is 12,7 cm, I am 177 cm tall, 63 kilos. How much should I descrease implant size and with in order to get a more natural look?

Doctor Answers 13

Natural results to correct tennis ball look (see photos)

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I know this is a crude example but it helps to make the point. If you hide a golf ball (implant) under a silk sheet (tissue), the appearance will be very ball-like. However, if you hide the baseball under a thick comforter, the thickness of the comforter will greatly influence the result. A very thick comforter may make the ball barely visible. The comforter will determine the overall appearance of the result. If you change the golf ball to a volley ball, it may appear more round.

In individuals with very little tissue ( thin athletic women with low body fat and an A cup breast), the breast implants may be more noticeable and will ultimately have a significant role in determining the appearance of the outcome.

In individuals with C or D cup breasts, the overall breast tissue and position of the gland will have a greater effect on the overall appearance of the final result.

How to get rid off "tennis ball" look...

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Dear Lisbeth,

The look you describe and i see in the picture is cause by too much volume in the upper part of the breast. Most likely they used a high profile prosthesis to "fit" the volume in your smaller chest!

I agree with you that a smaller implant size would have looked more natural. That might go in to the "american" perception of what is a proper size.... But, OK i am European...

Personally i would choose an anatomical silicon gel implant, remove the Perthese, make a new pocket under the current one and put it submuscular (under the muscle). The size should be discussed but it would defintely be smaller with a smaller width.

I hope this helps you, if you want more detailed feedback you are welcome to contact me,

Good luck,

Ivar van Heijningen, MD
Belgium Plastic Surgeon

Breast implants above vs. below the muscle

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The Perthes implant is a textured cohesive gel implant manufactured by a French company that is now owned by Mentor/Johnson and Johnson. It is not FDA approved and cannot be placed or replaced in the US. I was unable to find one of their implants that meet the dimensions you describe. The closet I could find are 340cc with 12.4cm base width and 4.9cm projection and 380cc with 13.3cm base width and 5cm projection.

Because implants do not blend in well with surrounding tissues at their edges the usual recommendation is to place the implants under the muscle for those who have very little body fat or breast tissue to start with, as in your case. The goal is to maximize the amount of tissue between the edge of the implant & the outside world/eye. The muscle we refer to is the pectoralis major whose lower border only reaches to the nipple or above the nipple in women. Thus only somewhere between 30 & 60% of the implant ends up being covered by muscle.

In my opinion your photo shows implants whose center is slightly below the level of the nipples which appear to be in the correct position and there is insufficient tissue covering the edges of the implants. If your natural breast base width before surgery was really 12.7cm your implant diameter should really be no more than 11.7cm. 10.7cm would even be better. Your solution would then be an 11.7cm or smaller diameter implant placed under the muscle. I suspect your current implants are above the muscle. If the model of implant used needs to be changed that can be done in any country with whatever implants are in general use there. The difficulty will now be how to get the pocket to shrink down around a new smaller diameter implant. This is less of an issue if the current pocket is above the muscle and the new one will be below it but you still may need suturing of the current capsule to raise the inframammary fold.

The wrong implant dimensions will give a less than optimal result even in the hands of the best surgeons.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Volume reduction may be of benefit

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Dear Lisbeth, I must admit I don't know much about Perthese implants (in fact I've never heard of them).  From your photo I think the problem is more one of implant descent.  The inframammary crease to nipple distance looks too long, more on the right than the left.  If you were to go smaller it would be necessary to repair or raise the crease to correct this problem.  I think repairing the crease to raise it and using the same size implant would also give you a very nice result.  I almost feel like if you put on an underwire bra you like the look of the implants.

There are many plastic surgeons in the USA who do this procedure however should there be a problem with one of the implants you could need to purchase new implants that are FDA approved.  Seek the opinion of several plastic surgeons before proceeding and good luck.  Dr Schuster in Boca Raton.

Implant Size for Breast Revision of Perthese Implants to create a natural look

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The size of the implants are based on a combination of a patient's goals and objectives and her anatomy. In order to provide a natural looking augmentation, the surgeon needs to evaluate many factors including soft tissue coverage, skin laxity, chest wall width, breast imprint width, the shape of the breasts and relative level of constriction to ensure that the breast implants are appropriate for your body. Consult in person with 3 experienced and expert board certified plastic surgeons to understand your objectives.

See a surgeon in your country

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The placement of your implants and the results of surgery are heavily impacted by the natural placement of your breasts. If you have widely set breasts before surgery, then you will most likely have widely set breasts afterward, with minimal cleavage. this could be the case for you. Please see an experienced board certified plastic surgeon to determine the best size/shape of implants for you. Your original body measurements (breast width, length, etc) need to be taken to help determine the best implants that will give you a more natural look.

Implant size to acheive goals

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I consider two factors when selecting implants for my patients:

1.Dimensional planning
2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look. Hope this helps.

Best wishes,

Dr. Basu

Breast augmentation revision

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I think you may benefit from revisionary surgery. This may involve removal and replacement of implants. However, I think breast implant pocket adjustment may also be indicated. For example, the implants seem to have settled too far down. Also the right breast implant seems to be medially  displaced. The positioning of your implants make the nipple–areola seem off centered in vertical and horizontal dimensions. The implant positioning may be improved with internal suture techniques (capsulorraphy).

If revisionary surgery Is decided upon, it will be very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
I hope this helps.

The reduction of the size is not the only thing that you will need

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The pictures that you have  attached are helpful. Your implants are too low and are bottoming out. The size of your implants are not too big ,but you are the one should make that decision. In general any implant size reduction or enlargement less than 50 c.c does not justify the surgery.

What implants would look natural for me?

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This is actually a rather difficult question to answer without actually examining you.  However, I can say that what appears to have happened is that you have a rather long nipple-fold distance and the volume of the implant has settled too low on the breast mound.  When it does that, the volume is not evenly distributed over the chest and the effect looks very unnatural.

My first recommendation would be a slight downsizing without narrowing the base width too much.  Keep in mind that because the round implants (which would be what a US surgeon would replace your current implants with) are round, the base width equals the height.  And so by reducing the width you would also effectively reduce the amount of volume to your upper pole resulting in an even more unnatural appearance. 

I would also recommend adjusting your fold so that the distance from your nipple to the fold would be shorter and the implant volume better distributed.

I hope that helps!

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.