You are an excellent candidate for a new
technique called Implant Exchange with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage. Aligning the areola, breast tissue and
implant over the bony prominence of the chest wall maximizes anterior projection
with a minimal size implant. Small round
textured silicone gel implants placed retro-pectoral look and feel more
natural, are more stable, less likely to ripple or have complications needing
revision. Implant profile is irrelevant
in the retro-pectoral position since the muscle compresses it. If you are a 34 DDD and want a C, the
implants would need to be 300 cc’s reduction.
Gary Horndeski, M.D.
Thank you for the question and pictures. Given your stated goals and photographs, it sounds like you will benefit from revisionary breast surgery. In my practice, I would likely offer you the following operation; conversion to the sub muscular pocket along with mastopexy (breast lifting). My best suggestion is careful selection of a board-certified plastic surgeon who can demonstrate significant experience with revisionary breast surgery and careful communication of your goals. I hope this, and the attached link, helps.
Because the degree of elasticity in the skin is difficult to predict, it might be worth considering having your implants deflated a couple of weeks before revision surgery. This can be done in the office, and would allow the skin to contract so that the lift you will almost certainly need can be done more accurately. Gel implants under the muscle will feel more natural.
I would recommend a single operation to remove the existing oversized implants from their submammary position and placing new, smaller gel implants in a submuscular pocket. I would suggest removing the majority of the existing breast capsule leaving only a portion along the inferior surface of the pectoralis major muscle. A vertical breast lift (inverted "T") would be done at the same time. Special attention would need to be paid to the vascularity of the nipple areola on the right because of the increased ptosis and longer pedicle length.
Yours is a very common situation but the good news is that you seem very resonable in your wanting a smaller size...I find that patients in your situation do very well with implants moved to under the muslce and then a breast lift done on top of that...the space under the msucle has not been used and responds well to a smaller implant. I do this all in one surgery but spreading them out is also an option..but a word of warning.. After your srugery you will feel like you don't have breasts! Because you are used to them being heavy and on the front of your chest, when going under the muscle they will feel much clsoer to you and much more secure....and for a bit...like you just dont have them any more!!!!
I would suggest removal or deflation of the current implants and then waiting for about 3 weeks or more to see how much of your skin retracts. After that, I would recommend replacement of the implants using a smaller silicone gel type in a new pocket under the muscle. At that time, you will also likely need to have some type of vertical breast lift for best results. This will allow a correction of the nipple position asymmetry.