Many women wrestle with the size of their implants within the first few weeks after their breast augmentation, believing they've gone too small. Such regret can cause some to prematurely consider revising to a larger implant, not realizing that it takes several months to a year for the breasts to settle into their proper position and take full shape. And probably most understated or underestimated is the time it takes to mentally and emotionally adjust to the size and look of the new bust.
It is not unusual for women to feel they've gone too small but then, after giving it six months to a year, they find that they are satisfied with their initial decision on size. Still, this is not always true for everyone. After about one year following your augmentation if you still feel that your breast implants are too small for your body, you should arrange a consultation with your surgeon to discuss your options. If this is you, here's how to avoid choosing the wrong size again and what to expect when moving up in cc's.
How to Choose the Right Size Breast Implant the Second Time Around
Most women feel that they went too conservative the first augmentation or that the look they had in mind was just not realistic for their anatomy. Choosing the appropriate size for your second surgery is imperative as it will prevent multiple surgeries down the road, as well as the potential for complications. Consider these tips to getting closer to the size you really want.
Now, this is not a hard and fast rule, so you will need to take further steps, but finding photos of a woman with your approximate shape and size (both body frame and breast implant size) will help give your board-certified plastic surgeon an idea of what you are looking to accomplish. And it helps to also put everything into context verbally, as well as have your surgeon reiterate that information back to you. If you did this the first time around and still were not satisfied with the results, perhaps you need to widen your net and consult with more surgeons until you find one you are confident can better deliver. Be sure to look at before and after pictures of patients he's performed breast augmentations on. Ask lots of questions. Think of it as an interview and ask hard-hitting questions that, if answered properly, will signal he or she is the person for the job.
The disappointment women have with their post-op size and shape often stems from not having realistic goals from the beginning. A breast augmentation alone will only give you a larger version of you, so to speak. You must additionally understand a breast augmentation's limitations. For instance, a breast augmentation will not fix breast ptosis, or sagging.
To avoid having unrealistic expectations—and this goes back to the above consideration—search for goal pictures on the gallery on Just Breast Implants, various plastic surgeons’ websites, and the sites of the breast implant manufacturer you are choosing to go with. Where some women get misguided is using images posted on social media or non-medical websites as their inspiration. This does nothing to stabilize your outlook, and this is why: many of those images have been enhanced and do not reflect realistic end results.
When making the decision to exchange your breast implants for a larger size, it is best to not have a certain number of cc's or cup size in mind. If a number is your only goal and driving point, you will likely be disappointed and you may find yourself signing up for a revision shortly after your second augmentation. If your end result was not what you had expected, discuss your concerns with your surgeon to avoid further dismay after your revision. But more importantly, try on temporary sizers until you find the look that suits your personality and end goal.
Understand the Limitations of Your Anatomy
During your consultation with your plastic surgeon, he or she should have taken your breast width diameter (BWD). These measurements, along with other details learned from your physical examination, tell your surgeon how big you can go. Some women may have wanted to go bigger, but their BWD wouldn't allow it. As a result, they may be unhappy with their size. However, you will want to consider the flip side: had your surgeon pushed the limitations of what your chest would allow, you may have run into complications like bottoming out or symmastia. Know that a good surgeon will tell you if your goals are realistic for your anatomy or not. Bear in mind, just because one wants a certain size implant, does not mean that it is always possible. Should you still be willing to push those limits, there are surgeons who can help you get there, but again, a good surgeon will want to take steps to avoid complications, which you will read about below.
Taking the Leap From Your First Breast Augmentation to Your Second
There are times when a patient’s anatomy is unable to accommodate the size implants she was after. When this happens, a surgeon will oftentimes place the max breast implant size the patient's anatomy can handle. Though this is small to the patient, these are only temporary. The implants are in place for 6 months to a year in order to give the breast tissue and skin the ability to stretch and later accommodate larger implants. This is known as staging, and it is done in the best interest of the patient. Going too large for your first breast augmentation will most likely lead to complications that could have been prevented.
A surgeon has a responsibility to insert an implant that can fit into their patient safely. If the desired look cannot be achieved in one surgery, the patient must be prepared to accept the reality of multiple surgeries in the future to reach their goals.
Common Risks Associated with Increasing Breast Implant Size
There are a few risks at stake when revising to a larger implant. Here are some to think about:
Many women are concerned about stretch marks. Regardless of implant size, however, stretch marks may or may not occur. It’s all in your genetics. Still, even if you are prone to stretch marks elsewhere, they may not appear on your breasts.
This is due to the weight of the implants. This is not a complication by definition, but more of a common concern among women pre- and post-augmentation. Even women with small implants can have a bit of natural hang to their breasts. It is determined by the patient’s tissue elasticity and density of the breast tissue. A lift would be required to prevent additional sagging or to correct a lot of sag, known as ptosis. It’s very difficult for any surgeon to completely defy the laws of gravity with very large implants long after the augmentation. For implants to maintain the very round appearance that is visible with some very large implants, one would need multiple surgeries, an aggressive lift if there is excess skin, and an internal bra or internal sutures to keep the implants from falling to a natural shape for a period of time.
This occurs when the implant has slipped below the pockets created by the surgeon, and can result from the weight of the implants. This may happen with one or both implants.
The tissue on the sternum continues to remain “puffy” long after the surgery. Occasionally, the implants may appear to touch under the skin giving an unnatural appearance known as uniboob. If the breast pocket has been overdissected to accommodate an implant that is too large, symmastia may result.
This is the medical term for tissue death. Necrosis may occur when the blood flow has been restricted to the area by implants that are too large and puts too much stress on the skin and tissue.
Other complications may include nipple sensitivity, scarring, infection and capsular contracture. While these, and those listed above, can happen whether you have had one or more breast augmentation, their chance of occurring are greater with each additional surgery.
Revisions and Increasing Breast Size
Revising to a larger implant size needs to be dissected into two categories: revisions with complications and revisions without complications.
Revisions with a Complication
When a complication such as bottoming out or symmastia occurs and you have to revise to correct the problem and you choose to exchange your implants for larger implants alongside the corrective surgery, the problems you have been experiencing could be magnified. Correcting the complication and upgrading your breast implants will have better results if performed in two separate surgeries. Many women who have bottomed out or have symmastia, choose to upgrade their implants at the same time of correction only to wonder why the same problems return shortly after their revision.
Complications from your previous surgery should be corrected prior to a volume increase. If you have 350 cc's now and you have bottoming out and symmastia, it is best to correct these problems first and to let your breast(s) heal before having 600 cc implants inserted.
Think of it this way: If you break a wine glass, glue it back together and attempt to pour wine into the glass immediately after gluing, it will fall apart and shatter into more pieces as it hits the surface, thus drumming up a bigger problem. The glue must set up and cure before the glass can be used again. The same goes for your breasts; the problem must be corrected before adding volume to your breasts.
Revisions without Prior Complications
If revising to increase volume alone, the recovery period is usually shorter and easier. Switching from over the muscle to under the muscle placement may not be as pain-free as staying over the muscle or under the muscle. If you have subpectoral implants currently, your muscles have already been dissected. If you are switching from subglandular to subpectoral, you should expect your revision to feel like an initial augmentation. However, if your implants are under the muscle and you switch to over the muscle, you will not experience the pain that you felt during your initial augmentation.
By Emily Ballew
Created December 2016