Emre Guvercin, MD, FEBOPRAS

Thanks for your question.
From your description and the photo, it appears you have signs of mild tuberous breast anatomy, which is more common than many people realize — especially in patients who’ve experienced weight fluctuations during adolescence.

This typically includes:

Lower pole underdevelopment
Asymmetry between the breasts
Wider areolas or conical shape
Now to your main question:

Can you fix asymmetry and fullness without a lift?
Yes — in selected cases like yours, a lift may not be necessary. Instead, the combination of:
Anatomically shaped implants (like Ergonomix or similar) to gently expand and round out the lower pole
And targeted fat grafting to smooth asymmetry and soften contours
…can give very natural, balanced results — without visible lift scars.
The key is to reshape and support the lower pole from within, rather than lifting skin from the outside.

This is an excellent and very thoughtful question — and it shows you’re doing the kind of research that leads to good, lasting results.
You're absolutely right that one of the common concerns with isolated lower face or neck lifts is skin “mismatch” or draping issues — especially when the rest of the face remains untreated.

But the truth is more nuanced.

When is a stand-alone neck or lower face lift a good idea?
There are many cases where targeted lifting is both safe and effective, such as:
Patients with early jowling or neck laxity, but good midface volume and skin tone
Patients who have previously had an upper facelift or eyelid surgery
Patients seeking more subtle, natural rejuvenation rather than a dramatic transformation
What are the risks of rippling or poor draping?
Yes, if tension is poorly managed, or if facial vectors are not respected, skin can bunch or ripple at the transition zones — particularly in front of the ear, jawline, or submental area. But this is not inevitable.
With the right technique, this can be avoided.

What techniques prevent this?
In my practice, I use deep plane or SMAS-based techniques, which allow for:
Layered repositioning of tissue (not just skin)
Smooth, natural blending between treated and untreated areas
Minimal tension at closure, reducing risk of rippling or visible scars
We also carefully plan vector alignment, so that any transition between lifted and unlifted areas flows naturally with your anatomy.
The key is personalized planning
A successful result doesn’t require treating everything — but it does require:
Choosing the right zone of intervention for your specific aging pattern
Using techniques that respect facial dynamics
Avoiding over-pulling or “patchwork” effects through proper lifting depth and direction

Thank you so much for your honest and vulnerable message — your frustration is real, and you’re absolutely not alone in feeling this way.
You’ve gone through:

Implant rupture
Implant exchange with size increase
Unilateral capsulectomy
And now deep regret about your new size and shape
This is more than cosmetic — it’s emotional, physical, and psychological.
Let’s address your main question directly:

Can an implant exchange or downsizing be done safely at 6 months?
Yes, in many cases — including post-capsulectomy — a secondary implant exchange can be safely performed around the 6-month mark, especially when:
Healing is stable
Scar tissue is soft
And the patient is emotionally and physically ready
You’re absolutely correct that smaller implants may require capsulorrhaphy (tightening of the internal pocket), and that this is easier to do once the capsule is more mature — but waiting a full year is not always necessary, especially if the patient is suffering.
In fact, the longer an oversized implant stays in place, the more it stretches skin and worsens long-term results, as you’ve correctly pointed out.

Emotional well-being matters too
It’s not just about tissue healing — your mental health and body image matter just as much. Living with a result that makes you miserable every day is not a sustainable plan, and it’s completely understandable that you’re seeking help now.

Thank you for sharing such a well-considered question — your attention to proportion, shape, and projection is exactly what leads to the best outcomes.
From your description:

You have an hourglass figure with a 13 cm breast base,
Most of your natural breast tissue is in the lower pole, and
Your main goal is to restore upper pole fullness without going into an unnatural or exaggerated projection.
Let’s break it down:
1. Concerns with high-projection implants are valid
You’re absolutely right to be cautious — Full or high-profile implants on a relatively narrow base (13 cm) can sometimes:
Look narrow and round ("ball-on-chest" effect),
Sit too far forward,
Or create the appearance of "implants wearing the breast," especially when placed over lower-heavy natural tissue.
2. A better match: Motiva Mini or Demi profile
In your case, a Motiva Round Mini or Demi profile would:
Respect your natural breast base,
Provide more natural horizontal width,
Still give you upper pole fullness, but in a gentle slope rather than a sharp, artificial curve.
3. Technique matters as much as implant
To achieve your desired result, I often use the Préserve Technique — a highly selective, anatomical augmentation that:
Focuses volume toward the upper pole, where you need it most,
Leaves lower pole tissue untouched and supported,
Provides a natural shape that flows with your body — not against it
This approach works particularly well in patients like you who already have adequate lower pole tissue and want a refined, elegant enhancement — not an exaggerated one.

Thank you for your question — your concerns about scarring are absolutely valid, especially with a history of keloid formation.
That said, what you’re hoping to achieve — a round, lifted, and fuller breast shape with around 300cc of volume — combined with what you suspect (likely tuberous breast anatomy) makes this a bit more complex than a simple "through the nipple" approach can solve.

Here’s why:

1. Periareolar (donut) lift alone won’t reshape tuberous breasts
Tuberous breasts often have:
A constricted lower pole
Enlarged areolas
Limited natural projection
A periareolar lift is typically insufficient to release lower pole constriction, and it often leads to:
Areolar widening
Poor lower pole shape
Unsatisfying projection, especially if an implant is added
2. Anchor (inverted T) incision gives full control over shape
In cases like yours, the best solution — both aesthetically and structurally — is often a Push-Up Lift using an inverted T incision. This technique allows:
Full control of lower pole shaping
Proper implant placement
Centralization of the nipple
And creation of a truly round and lifted breast, even with tuberous anatomy
3. Scar care is essential — but scarring is not inevitable
Even with a history of keloid scarring, careful planning can reduce risk:
Precise surgical closure
Tension-reducing techniques
Post-op scar therapies (silicone sheets, steroid injections, or laser)
Many patients with keloid-prone skin still heal beautifully with proper care.
If your goal is shape + volume + longevity, the right technique — even with a longer scar — will always give better results than a shortcut that leaves you disappointed.
Let the scar be a thin line — not a compromise in outcome.