My breasts can look quite bulky at times and sometimes just right. What size/shape would you recommend? (Photo)

Question

I am looking to replace my 20 year old breast implants. I’m 5’6” 130lbs, have 2 children (after implants) and am 44. I started with a 34B, then got 330 ccs and was a 34D, and am now a 32DDD with 550ccs, round, moderate profile. I am now considering downsizing to 475 or 500ccs. My breasts can look quite bulky at times and sometimes just right. What size/shape would you recommend? I am really struggling with implant size and shape, as I am not sure what is causing them to look so bulky at times

Gianfranco Frojo, MD · Answer

Secondary breast surgery needs to be approached completely differently than an initial implant placement breast augmentation surgery. The effects of the implant on the breast overtime must be accounted for (in addition to the aging process that is normal). I would recommend placing significantly smaller implants, adding an internal bra scaffold (Galaflex), and performing a breast lift. I would recommend seeing a board-certified or board-eligible plastic surgeon with actual training in plastic surgery and an aesthetic fellowship. I find it also very beneficial if the surgeon has 3D imaging that can help simulate your revisionary surgery prior to the actual case.  Best of luck!

Marguerite E. Aitken, MD, FACS · Answer

You might have to large of a width implant. Maybe one that is more narrow, more projection and firm(cohesive). Going down in size will help as well, but it depends on the look you want.

Daniel Barrett, MD · Answer

Dear SunnySoCal,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Douglas Taranow, DO, FACOS · Answer

Proper naked breast photos with anterior and both sides would aid in accurate assessments.  That being said...
Your breasts look very nice now, but you are in very good shape with a narrow waist line.  This makes the breast look even larger.  550cc implants are very large, even for your frame.  Downsizing would require more than 50cc's, so consider at least 75-100cc reduction.  I am still thinking of changing to a moderate + implant and suturing the lateral pockets so the implants stay more medial/midline, vs lateral towards the armpit.
Before photos also help in deciding on the new implants and any anatomical concerns.
Best wishes,
Dr. Taranow

Connie Hiers, MD, FACS · Answer

At 550 cc's, your implants are too large and heavy for your frame, so they will look bulky. You need to go back down to a size that better fits your frame and tissue. However, with such large implants, you have stretched and thinned your own tissue more and may need a lift.  I would suggest going back to 350, or 400 maximum.

My breasts can look quite bulky at times and sometimes just right. What size/shape would you recommend? (Photo)

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