The two case of the month patients have different breast shapes, but both benefit from breast implants using a different approach.
The smaller patient can only accommodate a more limited size implant as there is less room, both on the chest wall as well as tissue laxity projecting out. The concern is to set the lower fold of the breast and limit stretch from the nipple to the fold.
For the larger patient, she has more volume loss and extra tissue with drooping. She can have, and in fact needs, a larger implant to fill the empty space. The concern is to make sure the implant does not sit too high on the chest so that the breast does not just droop off the implant instead of the chest wall. The implant fills the lower empty space, but cannot give superior rounding at the same time. A bra accomplishes this readily. The approach is a compromise and avoids the scars, cost, and risk of a breast lift at the same time. A lift may be done at the same time using a smaller implant and understanding that the implant will still descend over time.
Mark D. Wigod, MD, FACS, providing Cosmetic and Reconstructive Plastic Surgery to Boise, Meridian, Treasure Valley and Southeastern Idaho.