Breast implant revision - will my results still give me a perky look even if I downsize?

Question

I originally had 325cc textured implants and with a second surgery I went up to 575cc b/c I wasn’t getting the cleavage I expected. Now my breasts fall out more to the sides and medially you can see a line where the implant starts. Now going back for a 3rd surgery to tighten up the capsules laterally and to downsize just a bit. My surgeon also mentioned massaging my muscles to allow implants to be more medial also mesh? will be used. With all mentioned will I still be a bit perky if downsizing?

Gary M. Horndeski, MD · Answer

The technique I recommend is explantation and 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 (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Shlomo Widder, MD · Answer

Dear Bretney,
   Thanks for posting your pictures and sorry for your sub optimal outcome. From observing your pictures you appear to be C cup size with the following problems:
1. Bottoming out. The sub mammary creases are too low and require inferior capsulorrhaphy (internal bra).
2. Lateral displacement of the implants. It requires lateral capsulorrhaphy (internal bra).
3. Wide cleavage. Requires medial capsulotomy (scar release). This procedure with the capsulorrhaphys will give you nice cleavage.
4. Superior capsule contracture. Requires superior capsulotomy. This procedure with the capsulorrhaphys will give a nicer full upper pole.
   This surgery will require you to wear a bra with wire 24/7  for at least 6 weeks to protect the internal bra suturing. I would recommend to use the same size implants since your current breasts' size appear nice and natural.
   The best approach to the above recommended procedures is via sub areola incision and I would strongly recommend to use saline implants that can be inserted through the sub areola incision , while silicone gel or gummy bear have to be placed in the pocket through a sub mammary incision , which makes the above mentioned repairs very difficult to do.
    Always, consult with experienced board certified plastic surgeons who perform surgery in accredited surgery facility for your safety. Most importantly , check the before and after pictures of redo breasts augmentation in the photo gallery to make sure that they are numerous, consistent and attractive with nice cleavage, perky and natural looking.
              Best of luck,
                              Dr Widder
                     widderplasticsurgery.com

Farbod Esmailian, MD · Answer

Although I do not see a photo from before having any surgery, it does appear that the way your chest and breast are placed, it is going to be difficult to get you a lot of cleavage. The process is pretty much what you have entailed with tightening up the pocket laterally to push the implant more medial, opening up the pocket more medially as well as reinforcing things with a mesh may be necessary. Going smaller will help with decreasing the width of the implant as to prevent having too much laterally, but there is a limit to how much smaller you should go as the smaller implant will be narrower and will make it more difficult to get the cleavage and medially fullness you desire.

Hope that helps.

Hope that helps.

Daniel Barrett, MD · Answer

Dear bretney15,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Tightening your lateral and inferior pockets will help "perk" up your breasts. I do agree with going smaller since your tissue is not supporting these heavy implants.  Your implants, however, will not still high on your chest.

Breast implant revision - will my results still give me a perky look even if I downsize?

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