Implant Exchange- 525 cc Saline Smooth Round Moderate to Silicone Ultra High Profile. I'm 5'2, what size would you recommend?

Question

Hi Docs. I experienced a rupture of my right implant 3 weeks ago and will be undergoing an exchange of both implants and a lift next week. I currently have 525cc on my left and the deflated was 540cc. I am 5'2". My PS recommends using somewhere in the range of 420cc-480cc ultra high profile silicone implants so get rid of my dreaded side boob (hitting it while working out), for upper pole fullness, and projection. Is this what you would recommend for my height?

Rian A. Maercks, MD · Answer

This type of breast augmentation revision brings Einstein's voice to my head:"The definition of insanity is doing the same thing over and over and expecting different results" - Albert EinsteinBe careful.  Trying to correct the failings of a dual-plane breast augmentation (what you currently have) with high profile implants just does not make sense.  The reason that you have what you call "side boob" is due to the technical execution of your original surgery and the implants that were used.  The sub muscular or "dual-plane" breast augmentation involves releasing the inferior aspect and >50% of the medial aspect of the pectorals major muscle.  The thought is that the muscle will ascend to help with the superior pole of the implant, however, the muscle always has tone and quickly returns as close to the superior chest wall as it can.  In the process it pushes the implant down and outward were there is no support and either instantly or over time becomes "side-boob."  The dual-plane technique is also characterized by a void between the breasts usually close to the width of a breast for the same reason.  To get projecting breasts surgeons often mistakenly(in my opinion) reach for higher projection implants- implants that are narrow and fit in the limited space the dual-plane technique allows the breast to sit in but big enough to satisfy the size demands of the patient.  The problem with this thought process is that it extends the fulcrum or  leverage of the pectoral forces on the implant to further stretch tissue and skin, creating a bigger "side boob" or lateral displacement problem.When I encounter patients with your problem I convert them to the subfascial plane in a technique I call Cold-Subfascial Revision Augmentation.  With this technique, I return the pectorals major muscle to a more natural anatomic position and harness the power of a more superficial structure called fascia to shape and support the new breast.  As far as implant selection, my philosophy is the polar opposite of thought with dual-plane or sub muscular augmentations.  I use form-stable "gummy bear implants" that are natural anatomic shapes and actually select wide implants that can create a natural cleavage and a nice lateral contour that does not get displaced into the axilla like your current breasts.  By harvesting pristine intact fascia I create a sort of internal support bra with a lateral wall that prevents the empty midline and the axillary "side boob"Remember, ultra-high profile implants end up transmitting more undesirable forces and accelerate breast aging and distortion despite their heavy marketing and widespread acceptance.  I would suggest changing planes to a technique that does not involve muscular force and choosing a lower profile wider implant.  I hope this helps!All the best,Rian A. Maercks M.D.

Tom J. Pousti, MD · Answer

Thank you for the question.  Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation revisionary 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're 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. 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.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.
I hope this (and the attached link, dedicated to revisionary breast surgery concerns) help.

Michael B. Tantillo, MD · Answer

Implant selection should be a thoughtful and logical process based on patient goals and examination.  If you have chosen your surgeon carefully, discussed your goals with her/him and she/he is giving you sound  advice then you will likely have a very good result.  Make sure you understand the aesthetics and risks of ultra high profile implants.

Jeffrey Zwiren, MD · Answer

An important step in the process would be to narrow the base diameter of the breast implant capsule.  This could be done with a capsulopexy or with the use of an ADM product such as Strattice.  I am not a fan of the ultra high profile implant since it is very compact and dense it has a high central load and is prone to stretch deformities.

Steven Wallach, MD · Answer

Without an exam in person it is impossible for me to tell you what might be appropriate, a narrower implant could improve the "side boob" look.

Implant Exchange- 525 cc Saline Smooth Round Moderate to Silicone Ultra High Profile. I'm 5'2, what size would you recommend?

Answers (6)

Answer: Correcting breast shape deformities

Answer: Correcting breast shape deformities

Answer: Implant exchange for 525cc

Answer: Implant exchange for 525cc

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Everything you need to know about Breast Implant Revision

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Implant Exchange- 525 cc Saline Smooth Round Moderate to Silicone Ultra High Profile. I'm 5'2, what size would you recommend?

Answers (6)

Answer: Correcting breast shape deformities

Answer: Correcting breast shape deformities

Answer: Implant exchange for 525cc

Answer: Implant exchange for 525cc

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Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.