This is a difficult decision.
It is not uncommon for plastic surgeons to stage or separate these operations.
No one can predict for sure, how your breasts will look after downsizing.
Let me offer an analogy which may help to explain:
If you look closely at your friends or women after the health club, you will see a variety of different looking stomachs following pregnancy. I have seen women who have had 3 children have an absolutely flat stomach that is more attractive than many 20 year olds. And I have seen women with one pregnancy who have had stretch marks extend over their entire stomach after one child. Do you think you could predict this before having their first child?
After you "deliver" the currentl implant from your breast, and the replace it with a smaller implant which will likely require a new pocket or capsulorrhaphy, it will be difficult to predict the contraction of your breast skin.
Therefore you can pre-emptively perform a breast lift or wait and see what will be required at a later date. Obviously, I understand the inconvenience of a two stage operation but if you want to do all you can to minimize scarring this may be your best result. I have been impressed, in my personal experience, that after removing implants that have been in place for over 20-30 years, the skin will contract better than I would have predicted. Of course, it may look as if they had some loss of upper fullness but they appear age appropriate for a 50-60 year old. This is just one surgeon's opinion so take it for what it is worth. This is an artistic as well as a medical judgement.
Given your height and weight, I would recommend that you investigate silicone implants with a preference for medium or high profiles to minimize the potential for rippling.
I hope this helps.
