I think a lift will be necessary if downsizing that much.
What you’re describing is trading out your implants for new
ones that will be about half the volume. This is almost certainly going to
require a lift at the same time to reshape your natural breast tissue—and yes,
the implant pocket—around the new, smaller implants. You should see very
beautiful, natural results as long as you choose a board certified plastic
surgeon with plenty of experience in breast implant revision surgery. I do
agree that choosing a smaller implant size and perhaps a different profile
shape will give you the softer, more natural look that’s closer to the photo
you posted. Be sure to bring that picture and any others that you feel are representative
of your ideal results along with you to your consultation.
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Downsizing can be tough in the sense that it is difficult to get into the patient's head to see if they would be happy with 100cc less, 150 cc's less, etc.. It is a discussion in person.
I dont see how this is possible. the pocket is way too big for a 270 cc implant. I would not put in a smooth implant. i would use a textured shaped highly cohesive gel and definitely do bilateral capsulorraphies