Every case is different

The answer for you depends upon your goals and the condition of your skin and the other tissues.

If your skin isn't too stretched out, it may be possible to go a little bit smaller and do a form of internal lift called a capsulorrhaphy. You would need to be evaluated to see if this is a reasonable option.

How high you can go without a lift depends upon where the nipples are; you don't want a high mound with the nipples low.

I disagree with one of the statements in the previous answer, regarding high profile implants. They add projection, not upper pole fullness.

The key is to match the implant diameter to your natural base diameter in the volume that you want. If you are going down in size, that is unlikely to be a high-profile implant.

It's difficult to know without examining you, but in order to downsize the volume of your implants as well as lift the breast and tighten the skin envelope around it, a lift will likely be required.

A silicone implant will also give you a more natural shape, look, and feel in some cases, so this is certainly an option.

I would recommend a formal consultation with a Board Certified Plastic Surgeon in your area, and he or she can review with you your options, but from your description, a lift may very likely be what is needed.

Good luck!

Dr. S

The lift of the breast is designed to elevate the nipple to a youthful position on the front of the breast and remove the extra skin that is allowing it to sit too low. First the implants are exchanged then the skin excess is custom tailored out to create your optimal shape and tone. It requires some scars but will be worth it in terms of the best shape and look.