I would like to remove my 375cc (over-inflated to 425) saline implants, placed 12 years ago, with 250-325cc silicone implants. My implants are above the muscle and incisions are peri-areolar. I am hoping to avoid a lift. I have been told by 2 plastic surgeons that my nipples lie at the correct level by examination. Both surgeons recommend that I just do an implant exchange or that I undergo an explant with lift, followed by a second procedure with implant replacement.
How Much Smaller an Implant Can I Get with an Implant Exchange Without Requiring a Lift? (photo)
Doctor Answers 9
Just based upon your photos, it looks like you will need implant exchange if you want to downsize. It does not look like you have alot of native tissue. An exam in person would be appropriate.
Downsizing your implants by 50-100 cc. should not cause much ptosis and will actually soften your appearance to a more natural look. I would exchange these to silicone plus profile mentor implants
Scaling down implant size
When considering a revision, it is important to identify the problems and what is to be done about them and what result that will achieve.
Based on your photos, your problems are that the implants placed were too big, the implants are overfilled, and they are above the pectorals muscle. This has resulted in stretch and distortion of your tissues. Properly fitted implants do not lift the breast and removing does not make them sag, but when the tissues are distorted, this could result in some sag effect with implant removal.
For revision/replacement I would advise an inframammary crease incision (which is the best incision to start with and this is one good reason -- capsule contracture is another), and leaving the diameter of the replacement the same or only slightly smaller than the existing one. The profile of the implant can be dropped without problem. If you have a medium profile implant you can drop it to a low profile implant (not called that in silicone gel-filled implants) and lose a half cup size. If you choose to leave the implants above the muscle you should definitely be using a silicone gel-filled implant. If you redo the whole thing you can start over with a properly sized implant below the pectorals muscle. This would be the best overall choice in my opinion.
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Requiring a lift with smaller implant exchange
From your pics and the way the implants appear on your chest, you have a grade II capsular contracture (mild to moderate). The capsular contracture causes visibility of the implant edge. You can have an implant exchange to 100cc smaller silicone implants as well as addressing the capsules. By performing either the capsulectomy or capsulotomy, the implants will sit lower on the chest and give a more natural shape to the breast. Your skin should redrape over the implant without need for a lift. I do not think that you need a 2 stage procedure. Good luck.
Implant exchange decision
the pic you provide does indeed have the above the muscle look. I understand your request. If you decided to keep the implants above the muscle, a 100 cc drop may not cause too much drooping. If you went below the muscle, a lift may be necessary if your skin doesn't tighten up on its own. It's hard to predict this.
A contoured gel implant is now available as well to help you with the decision about having a more natural contour.
Hope that is helpful to you.
Bennett Yang, MD
Will smaller implants require a lift?
This is a great question and a tough one to answer. From the photo you have included, the nipple position appears to be good. With such large implants place above the muscle, you have stretched the skin out and down sizing the implants will leave extra skin. The smaller the implant, the more the excess skin you will have. Having a detailed discussion with your plastic surgeon about your ideal look and size can help guide what can be done. One option is to down size and then perform a lift at another operation if needed. Another option is to perform a periareolar mastopexy (incision around the nipples) at the time of surgery if there is some excess skin and nipple descent that would create an unappealing look. Your surgeon can help guide you in a direction that fits your budget and timeline.
How Much Of A Decrease In Size Without A Lift
One of the frustrations for plastic surgeons when a patient is wanting to decrease her implant size many years after the original breast augmentation is the inability to accurately determine how much her breast tissues will shrink/retract after removing the old, larger implants. There is a lot of variability in these patients; some will shrink back to almost their original size and shape and no lift will be required and others will shrink very little and need a lift. This may be what your surgeon is trying to explain.
One option since you have saline implants is to have your surgeon deflate the implants using a needle and syringe in the office under local anesthesia and then wait a short period to determine if you are going to need a lift with your smaller implants or just implants. The only downsize is the period of time where your breast size will be smaller and some extra padding needed.
Hope this helps.
How much smaller breast implants
You have the typical look of subglandular implants in a thin person where you see the outline of the implant and no feathering of the edges as is seen with submuscular implants. If you like this look then going down 100cc may be OK It is hard to predict how well your skin will shrink. Good Luck!
How Much Smaller an Implant Can I Get with an Implant Exchange Without Requiring a Lift?
Among other considerations will be moving the implants behind the muscle this time.
It is hard to answer your question based only on a photo. I would guess that you could decrease the size by about 100 cc without leaving much skin excess.
I am not sure of the rationale for the suggested two stage procedure that was proposed. Perhaps another (in person) opinion would be sensible.
All the best.