475cc Saline Implants - Looking to Downsize and Switch to Silicone

I was insecure and didn't appreciate the nice body...

I was insecure and didn't appreciate the nice body I had. I wanted larger breasts. They're too big causing neck and back pain. Communication with my surgeon was poor and I found him to be dismissive of my questions post surgery. I regret having this surgery.

 My breast implants are saline, 475 cc's, high profile and are under the muscle. I have had them for six years. I am petite and they are quite large and heavy for my body causing neck and back pain. My right implant hangs lower than the left and it also has some slight rippling. I would like to go to a smaller size around 250cc's. I have also considered removing them (or going smaller and then removing them--I'm not sure of what steps would be involved for that type of procedure).

I had a consultation for a second opinion to discuss going to a smaller size implant. The second doctor said the right pocket has torn and he noticed it not only hangs lower but to the right as well. I will need reconstructive surgery to repair it.

He advised me to switch to silicone implants. He did not mention whether a lift would be necessary (I went from 32B to 34D). Although I understand that the appearance of silicone is more natural, I have many concerns about the health risks of silicone gel. He said if he replaced the implants with smaller saline implants they would look bad because of the rippling and thinness of the skin from having been a larger size.

My questions are: once there is rippling with saline is there likely to be more after a second surgery if switching to another saline implant? Is silicone my only option for my breasts to look good at this point? If I were to remove the implants, how does the process work? Thank you for any information and advice you can provide.
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Communication with my surgeon was poor and I found him to be dismissive of my questions post surgery. He encouraged me to go larger than the 250cc size I chose, saying the larger size would look so much smaller than it seemed when it was behind the muscle. They wound up being way too big for my body. I can't exercise the way I used to, even wearing two sportsbras.

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