Wise to downsize implants without pocket modification? Profile change?

Question

Hello! 8 months ago, I received 450 cc round smooth high profile Mentor implants. The result is a 28 G to H bra size and an unnatural look (in my opinion). I would like to have a more natural look, with a downward-sloping upper pole, and much smaller chest. Can I decrease to 300 cc without a pocket modification? Would a moderate /mod-plus profile fill the width of the pocket, while providing a less full upper pole? In your opinion, do my implants seem to wide for my chest? Thank you very much.

William Andrade, MD · Answer

Hello, your result looks excellent in my opinion, but your satisfaction with your body appearance is what matters.  Technically if you choose lower profile implants with a similar breast width, they could fit in the same pocket without it requiring any adjustment.  However, your surgeon would be the best source of advice whether your breasts would adjust to the smaller implants.

Jed H. Horowitz, MD, FACS · Answer

It is certainly feasible to #downsize to smaller implants and also alter the positioning; if possible. However, decreasing is size may also require a Breast #Lift to to #tighten loose skin, better optimize the end result. Any #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome.
The profile is determined by the amount of projection versus roundness that the you desire, as well as the size of the implant and size of your chest. As much as it's important to know what size bra you currently wear, the strap size is important to know as well. It affects the diameter of the cup and subsequently the diameter of the #breast implant that you choose. In my practice, about 15-20% of the patients are good candidates for silicone #shapedimplants.#Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle. This tends to more common in Europe and South America. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option, #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding. Your Plastic Surgeon will measure you to determine the best shape, size and placement of the #implants to be used. Lastly, another important element to a satisfying result of your #augmentation is realistic #expectations.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Sorry to hear you are not happy with the outcome. You have a nice result but if it is not what you were looking for, let me offer some options. If you are unhappy with the rounded upper pole, this is likely the result of choosing a round implant. If you want more of a sloped upper pole, then I think I wise choice would be an anatomically shaped implant. Your 450 cc implant has a width of around 12.8 cm with a projection of 5.1 cm. Mentor options for replacement:1) A medium height, moderate projection shaped implant: 355 cc, 13.0 cm W x 12.2 cm H x 4.6 cm P. This implant would be smaller in overall volume size but would preserve the width of your current implant, decrease the height, and also decrease the projection. 2) A medium height, moderate plus projection shaped implant: 420 cc, 13.0 cm W x 12.2 cm H x 5.5 cm P. This is essentially the same implant as #1, but provides some additional projection and more overall volume. The projection on this implant would be more than your current implant but the point of projection would be lower on the breast due to the anatomical shape of the implant.As you can see, this process to achieve your goals can be complicated and requires a lengthy discussion. Shaped implants come in all versions of height, width, projection and can be somewhat confusing, but might be the perfect answer for someone like you who is trying to get away from the typical "augmented" look. I think as long as you keep the width of the implant similar, you will require very little in the way of pocket modification.  Best of luck!

Brent Moelleken, MD · Answer

I am a strong believer in using internal pockets when downsizing implants.  It is more work, but you don't want to have the skin bear the brunt of the weight of the implant.  There are other find points of the surgery that are also important- anticipated nipple position, IMF position etc. that will require experience and judgment.

Farbod Esmailian, MD · Answer

Thank you for the photos.  Judging by the photos it appears that you are young and will likely do well with the skin retracting after down sizing.  I don't believe you will need any further procedures like lifts and so forth with a simple down size.  Looking at the implant diameters, going down from a HP of 450 to 300 Moderate plus, there is a significant diameter change.  I believe it would be significant enough that your surgeon may need to tighten the pocket/capsule.It is obviously best to be evaluated in person to discuss all your options more accurately.Good luck.

Wise to downsize implants without pocket modification? Profile change?

Answers (10)