I have 700cc subpectoral mod+ silicone. Periareolar incision. Flat chested preop, no asymmetry. I have mild symmastia & bottoming out.I want smaller implants about 350-400cc. Best approach to accomplish a great result? A staged procedure of removing implants with symmastia/bottoming out repair, then re-implanting after 6-12 months? I am 24, 5"5 and 110 lbs, no kids and don't want a lift. Skin is in great shape. Hoping it would shrink up nicely if explanting then reimplanting later.
Best Approach for Downsizing Breast Implants? (photo)
Doctor Answers 11
Breast implant reduction in size
I agree with the other posts and your remarks that a staged approach is best. I think you have a 50% chance of needing a lift so keep that in mind. Overall, think you will be happier in the long run with a smaller more proportional size for your frame. Good Luck!
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There may be some benefit in doing this in two stages. However, staying without implants for 4-6 months is usually not acceptable to most patients. I think a good result can be achieved in one stage where the implant is placed in a new pocket between your anterior capsule and the muscle. This will result in correcting your symmastia while at the same time closing the space from your previous implant.
On another note, the use of a 700 cc moderate plus implant was way too wide for your dimensions. With that volume a high profile implant should have been used.
Mini Ultimate Breast Lift and removal of implants
The best approach for you would be Mini Ultimate Breast Lift and removal of implants. At surgery your breast tissue is reshaped and displaced medially and elevated to create the cleavage and the upper pole fullness you desire. This could be done in 1 procedure or 2 if you would rather stage the procedures. The advantage of doing 2 procedures would be that with the implants removed, your skin will shrink and regain it's tone. In the 2nd surgery, less skin would need to be resected to create the desired shape and the Mini Ultimate Breast Lift performed.
Gary Horndeski, M.D.
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The degree of skin/tissue resiliency/contraction that will occur intraop is the main variable.
Thus, it may be sensible to allow your surgeon to make the choice between one or 2 stages at that time. Without any question, the use of Strattice is an important adjunct, but I would place it only during the same operation in which the new implants are to be placed. The use of that product makes the choice of pocket location less critical.
Staging of Breast Implant Revision
If your priority in pursuing revision of your outcome is to avoid a breast lift, I think that the stages approach you describe MAY help, by allowing your skin time to contract after removal of the large implants currently in place.
On the other hand, it is important for you to understand that i tis possible that even with this approach, a lift will be necessary to achieve your goals of a youthful and firm breast, as 700cc implants are very large and your skin has been stretched by them to a significant degree.
I would be very surprised that your skin is 'in great shape' if you were flat chested preop and now have 700cc implants. Your high resolution photos show little pink blood vessels in the skin of your breasts, indicating significant stretch injury. As you have pointed out, you are also bottomed out and have mild symmastia. I'd like to know where you nipples would lie with your arms at your side. Your situation is not simple, unfortunately.
Perhaps a staged approach (either surgical or in the office with a needle) is one way of seeing 'how things will shrink up', but your pockets will still be too close and too low, and that will need to be addressed in the subsequent operation. Please understand that there is no one that can predict with total success, and that once you go smaller, you may really need that lift, especially after correcting the lower pole of the pockets so that the smaller implants sit higher, supporting your already sagging nipples less.
Best of luck!
Best Approach for Downsizing Breast Implants?
I would replace the smaller implants in a subfascial pocket and use ACD or mesh to support the glandular tissue
Staged procedure is the best approach
The only way to possibly avoid lift is to give time for your tissue to heal and retract. I routinely do deflation for saline implants before revision surgery.
Best Approach for Downsizing Breast Implants? (photo)
There is no absolute "best way" to manage your situation, in my opinion, because nobody can predict with certainty the outcome of a given procedure or series of procedures. My approach would be to explant, perform bilateral capsulorrhaphies diminishing the size of submuscular pocket and adjusting position to accommodate your new size. Depending on skin thickness, may supplement with acellular dermal matrix or fat grafting, but if highly cohesive gel implant is selected, unlikely this will be necessary (opinion subject to findings on examination). No reason to anticipate you would need breast lift (my opinion), and no reason for "symmastia and bottoming out repair" if you plan two stages. If the exchange is carefully planned and skillfully executed and still doesn't work out, you may need revision, but this could happen even if two stages are planned from the beginning.
Breast implant revision
This is a tough situation because removing the implants and say exchanging for those 1/2 the size may require a lift to deal with the loose skin. If you remove the implants, then you will have to wait several months to have new ones placed, and there is no guarantee how the breasts will look when the implants are removed other than that they will be deflated. But they may also scar down.
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