Breast Augmentation Question From Palm Beach Gardens, FL

Breast Augmentation Question


One of the perennially popular topics we address at Atlantic Coast Aesthetics is that of breast augmentation, particularly breast implants. This week’s ACA Question of the Week for “Ask Dr. Pane” comes from a viewer in Palm Beach Gardens, and is concerned with downsizing one’s implants. The viewer says, “Hi there. Thank you for taking the time to read this post. I am wanting to downsize from 600cc’s to about 350ccs with an exchange as well as a lift. I had an augmentation done six years ago. They were always too big to me. I am concerned about the pocket under the muscle. When I lay on my back my breasts both lay on my sides. So my concern is if he puts a smaller implant what’s to keep it from swimming around? Is there a way to go OVER the muscle? Is that usually more costly?”

Dr. Pane points out that especially in cases where larger initial augmentations are done, the breasts falling to the side when the patient lies prone is quite common. Women who have large breasts either naturally or through surgical means often find this is the case, to varying degrees depending on a number of factors. However, in women with larger implants, over time the tissues surrounding the implant can and often do stretch under the force of gravity and daily activity, pronouncing the effect significantly.

In this case, Dr. Pane says that an implant placed over the muscle is an option, but it may not may deliver the most optimal outcome for this particular situation. This is because placing the implant over the muscle would require the formation of a new scar capsule and make it more likely that the implant would tend to “swim” or move around while the capsule forms. Instead, the better choice may be to place the replacement implant into the old scar capsule and then tighten up the capsule around the new implant. This would help reduce the chance of the implant moving and make the replacement procedure more comfortable and likely to succeed than the over-the-muscle procedure.

One concern many patients raise is whether a given surgeon will perform a replacement implant procedure, particularly when reducing the size of the implant. Dr. Pane says that many will not, largely because any revision surgery increases the likelihood of complications. Additionally, with implant reduction and replacement, many surgeons are not comfortable trying to remediate the scar capsule to fit the new implant after it has spent several years sizing itself to the initial implant. Dr. Pane points out that this is a procedure he is comfortable doing and with which he enjoys an excellent success and patient satisfaction rate.

In many cases, there is no “wrong” procedure or surgical route to a given outcome, only which route is most likely to produce the desired result with the least amount of risk. As Dr. Pane notes, pictures, physical descriptions and even a complete set of medical records can only tell so much about what a given patient can expect. There is really no substitute for an in-person clinical evaluation, as in this case, to determine how the current implants are resting within the scar capsule, what the patient’s intended outcome is and what surgical options will best suit the patient’s needs safely.

Because revision and remediation procedures tend to carry greater risks of postoperative complications, it is even more important to follow sound aftercare procedures as assigned by the surgeon or clinical staff. These protocols help reduce the risk of infection and exposure to environmental irritants while facilitating the healing process. It is also critical to maintain contact with the surgeon and/or staff both before and after the procedure and to make sure to report any potential warning signs of a problem or complication right away. In most cases, patients find there is nothing abnormal occurring, but it is better to be seen for a “false alarm” than to not be seen for a complication that could be dangerous or even fatal if not addressed quickly.

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If you have a cosmetic surgery-related question for Dr. Thomas A. Pane or the staff of Atlantic Coast Aesthetics, we’re always pleased to talk with current and prospective patients about their needs, desires and concerns. Simply email us at, follow our Facebook and Twitter pages or call us at (561) 442-4116. Your question may even be the next ACA Question of the Week, answered live in an upcoming “Ask Dr. Pane” segment on a live Google Hangout. These questions are valuable because they help us answer your question while getting the word out to others who share your interests and concerns. Remember, at ACA we believe the only bad question is the one you don’t ask!

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