Breast lift can help you end up with a great result

When downsizing the size of an implant, small increments can do well if the skin and other tissue around the breast implant is youthful- this tissue can then contract a small amount for a good aesthetic outcome.

You are describing a situation where you already have some "ptosis," or drooping of your breast form, and so it is likely something else will need to be done. It sounds like 10 years after your last operation, your are thinner, leaner, and likely healthier and want a more proportionate, athletic type of breast form.

Some of the important issues that will be involved in your surgery are the position of your implant with respect to your muscle and breast tissue, the location of the crease below your breast (your inframammary fold), and the current width of your chest wall.

I'm going to bet that with a replacement of your current implants with something smaller, and additionally a lift of your breast tissue to reshape it and replace it to a more youthful, higher position, you will be thrilled with the result.

Make sure you are evaluated by a ABPS board certified plastic surgeon who can take into account all of the important nuances involved in this kind of revision surgery.

Almost certainly you will want to consider a lift at the same time as your replacement surgery with a smaller implant.

If the skin is already loose (droopy), this problem will only become more pronounced once a smaller implant is placed.

A board certified plastic surgeon can go over the options with you.  You will certainly want to discuss where exactly the implants are (above/below the muscle) , what type of lift will give you the best appearance, whether a complete vs. partial capsulectomy is planned, drains, etc.  If possible, you can make this easier if you obtain records from your first surgery, so you know the exact cc size of the first implants.

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