Your Questions
Your Questions
Q: Dr. Eppley, I am interested in a breast augmentation revision. I currently have high profile 800cc silicone gel implants under the muscle. They are too big so I want smaller implants and a moderate profile. I have terrible scarring from an attempted perirareolar lift. My areolas are larger than my hands when I place them over it. I really want to resolve this issue after having this insecurity about my breasts for several years since the surgery.
A: Thank you for sending your pictures. I am assuming based on these pictures that these large implants and the periareolar lift were done in attempt to correct some breast sagging and thus avoid the scarring from either a vertical or full breast lifts. Given your present breast situation you have two breast augmentation revision options which would be highly influenced by how much implant size reduction you want. The options would be:
1) Downsize implants slightly (100 to 150cc) and do a large periareolar reduction. This will still leave your breasts with some sag and downward projection but would avoid any further extent of scarring.
2) Downsize your implant more significantly and do a vertical or a more complete vertical-horizontal type breast lift. This will create a more uplifted and smaller breast shape but with scars on the lower breast mound/ (but also with much smaller areolas as well)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a breast augmentation revision. My original breast implamt surgery was about a year ago. I feel like I paid to have big saggy boobs. I wanted a “fake” look and I don’t think my doctor was listening to me. When I lay down they fall to the sides. I have saline implants (500ccs overfilled) under the muscle. I have three kids so they were deflated beforehand and a little saggy. They don’t look horrible now but they are not what I wanted. I waned a very full upper. I think they look natural and I don’t like that. Attached are some pictures of my breasts from today.
A: In breast augmentation revision, it is extremely important to know from where you and where you want to go from here..and then determine if it is realistic and how it might be achieved. You obviously had some significant sagging beforehand so the implants have merely taken what you had and make it bigger…filling out the deflated breast mound. This leaves you with larger breasts that still have some sag and not the upper pole fullness that you want. You have three options for a breast augmentation revision. One is to simply place bigger implants. With indwelling 500ccs implants (let’s say 550 since they are overfilled), it would have to be a minimum of 250cc size increase to be significant and ‘fake’ looking. Even bigger implants will not lift up your breasts higher on your chest wall. This approach just gives you bigger breasts that through a volume increase would provide some greater upper pole fullness. The second option would be to keep your current breast implants and do a lift, putting them higher-up on your chest which would make them look rounder and higher. This will create scars to do so and would be challenging to do with your tight skin and keep your current size implants. Given the current shape and position of your breasts, the prospect of scars on your breasts does not seem justified even though they are somewhat low and still a little saggy. Lastly, you can just aim to keep them from falling to the sides so much.You can tighten the pocket (lateral suture capsule tightening) to keep them from falling to the sides. This would only improve but one problem that you currently see in your breast augmentation result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation revision. I had breast augmentation three years ago. Right after I had major issues with my right breast implant. It was smaller and now moves around a lot, almost like its not even in place now. In addition, it is painful. My previous surgeon went through my armpit to place them and whatever he tied his suture to it is no longer attached. And he doesn’t see an issue after multiple visits. I just want to cry. I have decided to move forward and have heard multiple positive reviews from patients that came to see Dr. Eppley. Very excited to see the light at the end of the tunnel!!!
A: It is hard to tell based on your description as to the exact nature of the problem with your right breast implant. Besides being smaller and moving around more, the source of the pain is not clear. Usually pain with breast implants is associated with either a tight pocket, capsular contracture or a ruptured silicone implant. I am going to assume that since your implants were placed through the armpit that they are saline implants.
Regardless at least a right breast implant revision is going to be needed. That will have to be done through a new inframammary fold incision. You talked about ‘ a suture that was tied that is no longer attached’ but such an entity during transaxillary breast augmentation surgery does not exist so that is an irrevelant issue. The question is whether this is a pocket adjustment with more volume added to the existing implant or whether a new implant is needed. This will require a physical examination to determine exactly what needs to be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my fiance recently had a breast augmentation done in early March 2012. After the surgery the doctor came to me and said she had issues closing up her right breast. She said her tissue was very weak and started to rip due to the sutures. After the surgery we kept a close eye on the healing process. This past weekend, five weeks after the surgery we noticed that the ‘scabbing’ had grown a lot. My fiance had me take a look today and it appears that the implant is actually showing. It looks as if the skin has opened up from the sutures and the implant is about to fall out. Is this a normal problem? She saw the doctor today and it appears that the implant must be removed and she has to wait until it heals up before replacing it again. Have you ever seen this problem before?
A: This is an unfortunate and rare complication after a primary breast augmentation. It is not one that I have seen before but the sequence of events are such that tissue necrosis occurred from wound tension over the inframammary fold incision site. Why it happened is relevant for the future since you do not want to have a repeat experience after implant replacement. I can only assume that the size of the implant placed too much stress on the incisional closure. If this was a problem, during the first procedure, that effect may be greater the second time. You may have to consider either a smaller implant or go through a process known as tissue expansion prior to implant placement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had breast augmentation about six months ago. I went from a 34B to a 34D and they are under the muscle. While the size is satisfactory, they still feel and look fake. They still feel hard, although not as hard as right after surgery. One breast is also higher than the other one and they have not dropped like my surgeon said they would. What do you recommend I do now?
A: While it is true that breast implants can initially be high due an immediate skin expansion effect, some settling or dropping of them can usually be expected as the lower breast skin relaxes. This is an effect that will occur within the first few months after surgery. I usually like to see it happen by no later than six weeks after surgery. While some settling can still occur up to several months later, you are at a point in time where no change will be seen. Besides a high position, your breast implants feel tight because the tissue pocket that contains them is somewhat too small. A small pocket around a bigger implant will feel tight or hard. What you need now is revisional surgery. The breast implant pockets need to be opened up on the lower pole, one side more than the other. This will drop down and even out the implants and, with larger pockets, make them feel softer. Breast augmentation revision is your next step.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I originally had breast augmentation three years ago and went from an A cup to a C cup. I got 375cc implant in now. I have decided that I would like to be bigger, at least another cup size. How do I know what next breast implant size to go to. My current plastic surgeon suggested 450cc but I am not sure. Is that enough of a size increase to get what I want?
A: There are a lot of variables that impact how a certain breast implant volume will look on any woman’s chest. There is no direct scale or measurement that can accurately predict for all women the correlation between breast implant volume and bra cup size.
That being said, you have one advantage over someone who is getting their initial breast augmentation. You know what cup size resulted from a specific volume. This does make it a little easier to predict what would happen with the next implant change as it is largely a matter of mathematics and proportionate relationships.
Going from 375cc to 450cc is a change of 75ccs or 20%. Based in your prior experience, it took 375cc to get a two cup size increase or roughly 175cc per each cup size increase. This would suggest then that a 75cc increase would only change your bra size by about a ½ cup size. To get a full cup size increase, it will take at least a volume increase of 125cc or a 33% increase in implant volume.
Dr. Barry Eppley
Indianapolis, Indiana