Sounds like you may have needed and would benefit still from lateral capsulorrhaphies (cinching in the outside most part of the pocket to centralize your implants). I recommend asking your surgeon and demonstrating how far apart they fall when lying down.

Published on Jul 11, 2012

Typically, decreasing the size of the implant such a small amount does not necessitate a change in the pocket dimensions. However, if your original implants had a wider diameter and your new high profile implants have a smaller diameter, that would explain the lack of upper pole fullness and the lateral displacement of the implants when you are lying down.

Published on Jul 11, 2012

Downsizing always has some risk of changing shape and shifting the volume. If the implant width is not the same as your pre-op implant, you may now have more "room" for the implant to move around with positional changes.

You can simulate upper pole fullness may with bras to your satisfaction. If the implants move too much for you to be happy, you may need a pocket revision.

Published on Jul 11, 2012

Without having been there at the time of the surgery it would be difficult to completely answer your question. From what you have told me, it sounds like the pocket for the implant on the lateral side (outside of your breasts) is a bit too big, so when you lay down there is a space for the implant to travel into. This would not necessarily show up at all when you are sitting up or standing.

High profile implants also have a narrower base size/width which gives them have a bit more space to move around. What I am trying to understand is the lack of upper pole fullness as HP implants project more significantly than moderate profile implants and should give you a bit more projection, not less, but you did go down in size which alters that equation.

My best advice is to address these questions with your surgeon. That doctor is best able to both identify your concerns and direct you to the proper solutions. Hope this helps.

J. Wethe, MD

Published on Jul 11, 2012

Unfortunately, when downsizing there can be issues if the pocket isn't altered. A lift of some type is often needed to tighten the skin envelope. I place all implants using a technique called "complete muscle coverage," which allows the implant to be completed covered/wrapped by the muscles to ensure stability, create attractive cleavage, and keep the implants from migrating laterally (the issue you are experiencing).

It also helps to provide more upper fullness. If the issue of no upper fullness is enough to warrant you having a revision surgery, I would recommend a candid conversation with your plastic surgeon. If not, you can certainly create upper fullness with the use of bras that are designed for that purpose.

Published on Jul 11, 2012

Thank you for the question.
Unfortunately, online consultants will not be able to give you good advice without performing an examination and knowing more details of your surgical history. Best to communicate with your surgeon and allow him/her to help you with your concerns.

Best wishes.

Tom Pousti MD
www.PoustiPlasticSurgery.com

Published on Jul 11, 2012

Unless an uplift or neopocket is done, then the shape will not change and it will be like it was before. You probably did (or will not) have much of a change, except it may feel more natural.

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery
Newport Beach, San Francisco,Miami, Italy, Anguilla
949.640-6324/1.888.234-5080(Ca)
FAX- 949.640-7347
Website: http://www.surgery-plastic.com
Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)
Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors
Plastic Surgery- 2005-2017
President,American Society of Bariatric Plastic Surgeons
www.ASBPS.org
Organoderm Skin care/ScaRxTape

Published on Jul 11, 2012

You lost upper pole fullness because your current implants have a smaller diameter than your previous implants. That means that they do not reach up as high as your old ones, losing upper pole reach. If they are falling to the sides, then the pocket is too large for your smaller Implants and need to be secured internally. I hope this helps.

Published on Jul 11, 2012

Did you want to "down size" significantly? Most definitely when switching from saline to silicone, the size/fullness/projection will all be less than silicone with the same cubic centimeters. Therefore, if you and your surgeon decided to both switch to silicone and to decrease the your cubic centimeters by nearly 20%, then you both intended on a significant smaller appearance. If you are not comfortable with your result specifically insufficient upper pole fullness and lateral fall out, you may need to consider a revision surgery with an internal repair (capsulorraphy) to move your implants in and up as well as possibly larger silicone implants.

Published on Jul 11, 2012