11 months ago
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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