It depends on how large of an implant was used and how stretched the skin-soft tissue envelope is. If you feel the implants are too big for you...you have several options.
If you still want some degree of added fullness (more than before breast augmentation) than some degree of "down- sizing" of the implants would be recommended. Sometimes this will necessitate a breast lift (mastopexy) and other times it may not. It really depends on how much if any residual soft tissue laxity remains after changing to a smaller implant after a period of time for healing. Some patients may "meet criteria" for a breast lift (mastopexy) but are really happy with the breast appearance even with a small degree of laxity and leave the breasts just as they are.
If you are tentative about a breast-lift then I would simply do the down-sizing first and let everything "settle". After 6 months you can decide if you think you need a lift. If the breast is still droopy and the nipple position is low, then the liklihood is that you would need and probably want to have a breast lift.
If you know that you absolutely don't want implants any more then I would recommend simply to have them removed and wait and let everything heal; however, it is important to realize that if you decide on removal rather than down-sizing...you are more likely to need a breast lift in time.
Good Luck
James F. Boynton MD FACS
