Will Natrelle full profile, 485cc, over the muscle, look unnatural? (Photos)

Question

2 years later after BA, developed cap con in the left breast, going to replace both implants. Going from Natrelle Inspira 375cc, mod profile, unders to maybe Natrelle Inspira FULL profile, 485cc overs in hopes to achieve more upper pole fullness. Don't want to go bigger, but fuller. My frame is 5'6", 215 pds, 15bwd. Dr suggested I go with Natrelle Extra Full profile, 545cc, but I feel that will be too big :( . Thank you in advance.

Gregory T. Lynam, MD · Answer

The information yo are presenting does not make sense since we know above the muscle implants have a much higher risk of CC and bottoming out since no muscle to hold implant against the chest wall. The thoughts that I have are as follows. Remove both implants and perform a mastopexy that really lifts your tissue. At a second operation 4-8 months later place new implants. Yes this seems like a lot but doing another less then ideal operation which is what I think you are looking at now IMHO is a bad idea. Seek out a few well respected board certified plastic surgeons please. Good Luck

Gary M. Horndeski, MD · Answer

Unfortunately, you had an improper lift.  The Wise pattern is notorious for bottoming out.  At this time, I recommend explantation and a 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 and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

William Bruno, MD · Answer

Discuss with your surgeon in more detail if you are planning to have your new implants placed on top of the muscle (subglandular) as this has a higher incidence of recurrence of capsular contracture. It's also recommended to use a textured implant in that case, which is associated with ALCL. These issues are more important than implant volume.Best wishes,Dr.Bruno

Gregory Baum, MD · Answer

Based on your photos, I think you need a revision of your breast lift and perhaps slightly larger implants to give you the upper pole fullness you are looking for. Switching the implants to on top of the muscle will likely cause significant bottoming out, less upper pole fullness with time, and an increased risk of recurrent capsular contracture. Best regards.

Daniel Barrett, MD · Answer

Dear curvyme123,
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

Robert L. Kraft, MD, FACS · Answer

I do not recommend going over the muscle. The result will not be an improvement and you will be even more susceptible to sagging, contracture and wrinkling.  You need a breast lift and smaller implants to achieve upper pole volume combined with proper placement on the chest. Best wishes.

Tom J. Pousti, MD · Answer

Although it is possible to have breast implants replaced in the sub glandular position, I do not think that it  will be in your best interest to do so.  Generally, breast implants placement subglandular position can be problematic; concerns such as rippling, palpability, encapsulation,  accelerated "sagging" of the breasts…may arise.

My best advice: more communication.

It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.

Other considerations: if you are not at your long-term stable weight currently, best to achieve your long-term stable weight prior to proceeding with elective breast surgery.  Doing so will help minimize changes that may occur in the event of weight loss after the breast operation (and decrease chances that additional surgery will be necessary subsequently.  Also, in order to achieve "more upper pole fulness", adjustment of the breast implant capsules (capsulorraphy) and/or revisionary breast lifting may be beneficial.

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.

Will Natrelle full profile, 485cc, over the muscle, look unnatural? (Photos)

Answers (7)

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