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Dissatisfaction With Implant Size (Too Small or Too Large)

A common reason for implant revision surgery is the woman’s dissatisfaction with the size of her implants.

Initial size may not turn out as expected.

Often surgeons will choose a size for a patient “that’s right for her.” The patient may be too trusting in her doctor’s judgement as what is best, and relying on a cup size rather than a visual representation of the desired proportion can cause implant selection to not meet the patient’s expectation. Some doctors emphasize achieving an ideal breast shape with an anatomical implant system that restricts size/proportion options available to the patient. A patient not having the size/proportion that meets her expectation initially is a candidate for revision.

Physical changes might make the implant size no longer appropriate.

Breast tissue can shrink with time (atrophy), and weight loss affects the breast to some extent. The breast can just seem smaller that they were initially. Weight gain can make breasts too large, which can make the patient look heavier. In addition, patients with larger implants may develop back or shoulder discomfort.

Psychological developments over time can cause once-appropriate implants to be no longer right.

Lifestyle changes with the introduction of a healthy diet and vigorous exercise may make sizeable implants more of a burden than a benefit. What was once desired is no longer wanted. Women may feel more comfortable with smaller implants or no implants at all.

Treatment for implant size issues:

The patient needs to help her doctor by bringing images of the proportions desired.

Surgery to reduce implant size can be a simple removal and replacement with smaller implants. Recovery is about a day, and an implant stabilization strap is worn across the upper breasts for a few days.

Surgery to upsize implants involves capsulotomy or capsulectomy. Recovery may be a long weekend, and discomfort is much less than the original implant operation.

Implant removal alone is also possible. If the patient is not completely sure, saline implants can be deflated by a needle in the office as a trial. Then, with greater patient certainty, subsequent surgery to remove the implant shell or insert a smaller implant can be accomplished. Implants can be removed without breast lift surgery in most cases.


Breast Implant Revision Frequently Asked Questions

Am I a good candidate for Breast Implant Revision?

A consultation is best to determine the concerns, identify specific problem areas, and determine how best to achieve the patient’s desired outcome. Only when the desired end result is known can the procedure(s) to achieve that be determined.

After discussing the patient’s concerns, Dr. Pertsch performs an examination to evaluate each breast’s issues. then show images of other patients’ “before and after” photos of other patients who have undergone breast revision surgery. These previous patients’ chosen solutions and results are helpful to demonstrate the range of possibilities and help the current patient narrow what might be acceptable options for herself.

Do I need to have my implants replaced if they are older than ten years?

Breast implants do not need to be replaced routinely or “in advance” of a problem. If one side has to be replaced, the unaffected side is often replaced at the same time while under anesthesia. Often, different (i.e., new) implants are selected to achieve the patient’s desired appearance.

What procedures are needed for successful breast implant revision?

A brief follow-up consultation may be needed where the patient brings additional model images to further illustrate her desired result and confirm the nature of procedures needed.

Patients are asked to find images of models undressed from the waist up to demonstrate their desire outcome, including breast proportion, shape, and position. (Our office has over 1300 pages of photos, each with multiple images, to save patients time finding helpful images on their own.) These images are reviewed with Dr. Pertsch to determine the procedures needed to achieve the patient’s ideal result. All patient concerns, questions about the many options available, anticipated recovery time, and financial matters and recovery concerns are addressed before proceeding with surgery. As many visits as necessary may be arranged until all procedures are decided and understood.

How is my breast volume and look determined? How is breast implant size determined?

At the preop visit, the final implant size is determined, so implants to be available for surgery can be custom ordered for each patient. Before visiting with Dr. Pertsch, the patient finds images of models to demonstrate her desired outcome, including breast proportion, shape, and position. The images of the models depicted are undressed from the waist up at a 45-degree angle. Patients shouldn’t get caught up in finding models with their exact same height and weight but focus on the overall proportion to demonstrate their desired outcome. (In the office, there are binders with over 1300 pages of photos, each with multiple image of models’ breasts to review, and this can save the patient time from finding helpful images on her own. Come early for the preop visit, or stay later after the preliminary visits to review and choose, and have images printed in the office to facilitate review with Dr. Pertsch).

After review of these images, one of the office stretchy sizing brassieres is used to complete size determination. Various sizer implants are tried on in front of the mirror. (For smaller volume increases rice added to zip lock bags is used instead of actual implants.) Differences between selected images and in-brassiere sizer exercises are discussed and resolved. The selected implant sizer volume can be further refined, adding or subtracting a tablespoonful or two, to account for asymmetries or any breast tissue reduction planned and final implant volume determination made. After considering the patient’s breast base width measurement, the appropriate implant projection can be decided.

An array of implants is ordered and available during surgery. This proves invaluable for surprises inevitable during revision surgeries: original implant volume different than expected, capsule thicker thus more removed than planned, more tissue removed than estimated to sculpt the side of the breast, etc. The patient’s ideal model images are also in the surgery room for comparison. Thus, decisions are made during surgery that will best achieve the patient’s desired outcome.

How long is recovery?

Recovery depends on the extent of the procedure necessary. It is usually shorter than the original surgery until activities can be resumed. If adjusting the pectoralis muscle is necessary, recovery is similar to the original breast augmentation. Exercise is avoided for two weeks. If capsulorrhaphy is performed or Strattice used, strenuous arm use should be avoided for six weeks, and an under breast support may be needed to allow for proper healing.

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