Smaller Implants Placing Under the Muscle with Scar Revision. Is This Possible for Me? Maybe a Complete Removal? (photo)

Had my breast augmentation 4 years ago,Ive always worried and been upset over my scars as they are so different to each other & my nipples are odd.I got pushed into a swimming pool soon after my op & Im wondering if that could have been a cause?After the swelling had gone down I knew my implants were too big, they are also over the muscle. Im now fed up of embarrassment in front of my partner and wish to fix my problems. I really dont want a lift and would like smaller & under muscle.Thank you.

Doctor Answers 8

Exchanging larger implants for smaller

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Exchanging your implants for  smaller ones while converting to a submuscular pocket will solve some of your problems. It will help with the rippling and allow an opportunity to correct the shape differences on your left side.  

I assume that your incisions are at the areola on both sides. The left breast scar is noticeable and could be improved, the right breast scar looks to be well healed.  

Keep in mind that if you go too much smaller in terms of implant size, your breasts will droop more.  You might consider a 50-75 cc smaller size and also exchange to a wider base implant such as a moderate (provided you already have a Moderate Plus or High Profile type implant).

Implant exchange and pocket change

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An in office exam is critical, but if you want them smaller and under the muscle that is possible.  As for a lift it is difficult to say but you may need it.  Again an in office exam would be most helpful.

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

You should be able to change to smaller implants in a submuscular position

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you should be able to change to smaller implants in a submuscular position, because your skin looks like it will have no problem retracting.

Smaller Implants Placing Under the Muscle with Scar Revision. Is This Possible for Me? Maybe a Complete Removal? (photo)

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Thanks for the questions and posting photos. Over the internet in complex issues very hard to advise. Yes going under muscle and correcting the pocket would/should help. But seek in person examinations to fully understand what is involved. 

Smaller Breast Implant As A Revision Without A Lift

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Thank you for sharing you photos along with your concerns.

After having implants for 4 years, removing your implants may not provide you with the same breasts you had 4 years ago prior to your surgery.

With perspective, deciding on considerably smaller implants may require a lollipop lift to prevent ptosis.

At this point, your best bet may be to think about having relatively smaller implants with a circumareolar lift through which you will have your nipples and areolae more symmetrical than what they are in the photos.

That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.
I hope this helps and please feel free to check the website below.

Thank you for your inquiry.
The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Bigger over muscle to smaller under the muscle

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Having an implant exchange to a smaller size and going under the muscle while tailoring the skin underneith the breast to prevent (ptosis) sagging would be the ideal decison for you to address the size and rippling issue you are experiencing. If you are open to a slight areola reduction this could help with assymetry of your nipples and fix your scar you are unhappy with. Wishing you all the best.

Smaller Implants Placing Under the Muscle with Scar Revision

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All of that is indeed possible. Without seeing pre-op photos it is not possible to comment on the added sag to the left side, but I would say this is a nice result, albeit unsatisfying to you. Putting in a modestly smaller implant should not put you at risk for "needing" a breast lift, though complete removal might. The scar on the left would be used for the exchange on that side and would be revised at the same time. Placing the implants under the muscle will decrease the chance of seeing and feeling ripples. The differential in sagging will probably not change without some kind of lift, but if this were the only issue, it is not asymmetric enough to my eye to justify the incisions needed.

Thanks for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Revisionary Breast Augmentation Concerns...

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Thank you for the question and pictures.

Yes, the operation that you are considering is potentially a very good solution to improving your concerns. Having said that, this operation must be done very carefully and will require (in my opinion) internal suture repair of the relatively large breast implant pockets (capsulorraphy). I would suggest the use of silicone gel breast implants in the sub muscular ( dual plane) position along with capsulorraphy.  Your scars can be improved with scar revision surgery at the same time.

 Select your plastic surgeon carefully and ask to see lots of examples of his/her work.  Then communicate your goals in regards to size etc.  In my practice I find the use of goal pictures very helpful.

 Best wishes.

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.