A large amount of saline cannot be taken out of implants without problems

This rather a difficult situation and several things need to be considered.  In order to remove any saline out of an implant the pocket needs to be reopened and the implant totally removed from the breast , the saline removed and then the implant replaced.  This is obviously a surgical procedure and may be more than you want to undertake.That said there is a recommended fill volume for saline implants and underfilling implants can  lead to folds which in turn may lead to failure or leakage of the implant.  I think you really need to sit down with your plastic surgeon and decide what you want to acheive.  Once you have established what your goals are then a plan can be made.  This plan might be (1)to remove the implants totally, (2)remove your current implants and replace them with smaller ones, either saline or silicone, (3)perform a lift without touching your current implants or (4)to remove the implants and do a lift at the same time.  The most important thing is to sort out your goals and then go from there.

Saline implants should generally not be underinflated.  They tend to ripple and fail mechanically if they are underinflated.

Simply replacing a large implant with a smaller one can create a deflated, lopsided breast.  It is not just an issue of placing a smaller implant in the pocket, which will still be much larger than the incoming smaller implant.  If nothing is done to the old pocket, the new implant will simply sit too far down and to the side and the breast will appear deflated.  Therefore, the internal capsule should be tightened as well.  This is a tricky procedure and much more complex than a breast augmentation.  However it is well worth it in the right patient.

Also a consideration for patients contemplating a smaller implant is whether they will require a breast lift at the same time; if the skin is saggy, breasts may appear deflated unless a lift is performed.  There are complexities with this surgery as well, i.e. what is the circulation, was the nipple-areola compromised during previous surgeries (i.e. by a submammary dissection).

Many patients actually consider having their implants removed completely and having a lift.  This is an excellent option for women who still have enough breast tissue.

Revision breast surgery can be very satisfying for patients, but it should be carefully planned with both aesthetic and anatomic concerns in mind.

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Saline Breast implants are designed to be semi-permanent implantable devices.  They are composed of an outer shell of silicone with an inner fill of normal saline (salt water).  In most cases, the skin and breast parenchyma form a sufficient envelope around the breast to produce an aesthetically pleasing breast shape.

Breast aesthetics is thus a composite of breast volume, nipple position, skin envelope, contour, and symmetry.

Merely reducing the size of an existing implant will thus alter several other important factors in breast aesthetics.  It may alter the skin envelope, total volume, shape, symmetry, and nipple position.  It may also cause premature sagging of the existing breast.

Also, all saline breast implants have minimum fill sizes that are within 10 to 15 % of your existing breast size.  Removing excessive saline may compromise the integrity of the implant.

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If you would like to decrease the size of an implant, this will require another surgery.

You may be able to keep the same implant if you only want a small amount removed. For example, 25-50 cc, depending on the implant.

Implants have a range of saline they need inside in order to maintain their shape. If you go below this range, the implant will collapse on itself. This will depend on the implant you have and how much saline was put in during the initial surgery.

Thus, if you want to remove a large amount of saline from the implant, you will need to replace the implant for a smaller one.

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If you currently have 375cc saline implants and would like to end up with 225-275cc you will definitely need new implants as the implants can only be filled to a certain volume. Ex. your 375 cc implant  can be filled from 350-375, but it can't be deflated all the way down into the 225-275cc range.

Converting from 375cc to 225-275cc could possibly leave you with some excess skin or possibly affect your nipple position. You should be evaluated by a board certified plastic surgeon to determine the need, if any, of a potential breast lift, or to decided if the procedure needs to be staged, i.e. first remove the larger implants then a few months later, after the skin has contracted a bit, replace with smaller implants thus avoiding the additional scars that a lift may require.

Best wishes!

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