I Am Wanting to Have Large Implants Exchanged for Smaller Ones, What About the Risk of Loose Skin?

If your current size is 32 DD and you desire a C, that is 3 cup sizes smaller.  For a 32 inch chest that corresponds to 300 cc's.  Your 350 cc implants can be removed and excess skin resected through a circumareola approach.  Without the implants, your breasts will droop and you will need a mastopexy.  Depending on how ptotic it is, it is possible that it can all be done through the circumareola incision.  It is important that your remaining breast tissue is lifted on the chest wall and your nipples horizontally aligned to give you more youthful perky appearance.

Best of Luck,

Gary Horndeski, M.D.

Considering you have a DD-cup breast size with a 350 mL overfilled implant you must have medium sized breasts baseline.  You have two very good options for obtaining your goal of a less droopy C-cup breast.Option 1: Deflate your current 350 mL overfilled saline implants in the office under local anesthesia then allow the skin to contract for 3-4 weeks (Simple procedure where using local anesthesia you poke a small needle hold in the implant and repeatedly draw out fluid until the implant is deflated).  Follow this with and implant replacement and tightening of the pocket (capsulorrhaphy) using implants in that are 100-150 mL smaller.  Since your skin is loose I would strongly consider changing to cohesive gel silicone implants (Allergan Natrelle Inspira Style SRF, SSF or SCF) which help decrease the chance of ripples.   With the contracted breast skin a breast lift can often be avoided.  If necessary, I reinforce the pocket with GalaForm Mesh.  This is an absorbable mesh which is replaced by tissue 3-5 times stronger and helps thicken the typical pocket.Option 2:  Remove the implants and replace them immediately with cohesive silicone gel implant in the same plane along with a periareolar mastopexy or vertical mastopexy to remove the loose skin.  This allows complete control of breast size and shape since the size and shape of the implant and skin envelope are all within the surgeons grasp.  In addition, Galaflex Mesh (absorbable reinforcement mesh) can be used to reinforce the breast lift.  While this approach gives the best shape overall and the most dramatic breast lift, it does result in additional scars which are usually thin lines which are not very noticeable.

Thanks for your question.  I dedicate a large portion of my aesthetic plastic surgery practice to revision breast surgery.  I think the "fear" in down-sizing implant cases is always that "I might need a lift".  A lift is always a possibility in down-sizing; however, it doesn't have to be done at the time of the removal and replacement.  It can be done in a staged fashion.  One thing I think that can be very helpful in patients with existing saline breast implant which it sounds like you may have from your description is a "pre-deflation" of the saline implants.  This is something I recommend when patients want to be smaller.  This involved "draining" the saline implants with a small needle in a simple office-based procedure which takes about 10-15 minutes.  We typically recommend doing this 4-6 weeks before the actual "removal and replacement" implant surgery.  This allows the "pocket" to shrink some before surgery and allow for a smaller (usually silicone gel breast implant) to be placed at the time of surgery, many times without a lift. Sometimes we have to supplement the breast implant with an ADM (acellular dermal matrix) such as Strattice or Galaflex.  This does not mean that you will not need a lift; however, it may give you "your best chance" of trying to avoid a lift and still get a smaller implant in a down-sizing scenario.  I think is an excellent option in patients that want to be smaller that have saline breast implants.  I hope this is helpful.  Good luck!

Yes, it is possible to #increase your implant size with a #revision. However, the #pocket will need adjustment and a lift may be necessary; to better #support the new implant. Additionally, a mesh for further support may be helpful depending on the #implant size and skin #elasticity.Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for further revision surgeries. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Thank you for inquiry.Your
first step is to be properly examined by a Board Certified Plastic
Surgeon.He/She will be able to tell you
if it is feasible for you to get smaller implants without any lifts or internal
sutures.They will have to check for
several things.For instance, if you
have stretch marks on your breasts, this might be an indication that you have
some skin laxity.They would have to see
how much smaller you want to go with your size and what your nipple position is
currently and if that will change with the smaller implants.So, I think a consultation with your Plastic
Surgeon is indicated here to accurately answer your question.

When breast augmentation patients are unhappy with
breast size, the majority would like to have larger implants.It’s unusual for patients to want smaller
implants, but never the less this occasionally does happen.This may occur for a variety of reasons, but
when it does happens, it represents a surgical challenge.Although these cases are challenging, with
careful attention to detail, results can still be excellent.The
presence of larger implants results in stretching of the overlying soft tissue
and increased breast pocket size.When
undergoing removal and replacement with smaller implants, these issues must be
dealt with to obtain an optimal result.In some cases, the breast pocket will need to be adjusted to avoid
excessive implant displacement.This
type of movement can be minimized by utilizing implants with wider base
dimensions.This will also tend to
create a more natural appearance and will hopefully address this concern as
well.Breast
size is also an important issue, but discussion is always difficult because cup
size means different things to different people.For this reason, we strive for harmony,
balance and proportion when selecting breast implants.It’s
important to discuss all of these issues with your plastic surgeon before
proceeding with this procedure.With
careful attention to these details results can be excellent.

The two unknowns in your situation are 1) what size of implants should be placed? and 2) will you need a lift after downsizing the implants?

 Here is a counter-intuitive idea for you that I have used several times....deflate the implants.

This is a very simple awake office procedure with basically no pain.  You will instantly be able to start over in the decision process regarding size and need for a lift.  It is much easier to "simulate" addition of volume to pick your implant size.  You may discover that you are a small C cup without implants and a lift is all that is necessary.

Of course, a component of the eventual surgery requires implant removal which is quite easy. 

It is certainly possible to go to a smaller volume implant.  Your body does not like empty space and, if you have good skin elasticity, should tighten down around the new, smaller implant just as it does when we remove fat during liposuction.  As to the question about which volume implant will give you the cup size you are looking for, this is something you will have to work out in conjunction with your plastic surgeon.  Bra manufacturers do not make standard cup sizes.

 

Without seeing photos or seeing you in person, it is impossible to give you specific advice.  However, if you are exchanging your breast implants for smaller ones, most likely you will need a breast lift to achieve the best looking  and most natural result.  Otherwise, your may have ptotic (sagging) skin.  If the size exchange is very slight, then the lift may be avoided.

 

Good luck.

Thanks for your question. The amount of laxity going to a smaller size is often hard to determine until the new implants are placed. The better your skin tone, the less droop you may have. The smaller the difference in implant size the smaller the change in the skin.

It sounds like you have saline implants. Just before surgery I will sometimes have patients come into the office and deflate the implants with a needle while patients look on.  This can help the patient decide when the volume is correct. Sometimes I will fully deflate the implant and the patient can try on sizers again.

You and your surgeon will have to determine if you may need a lift or tightening of the skin.  Smaller implants may have a smaller diameter and this may make the nipple look higher.