Breast Implant Size and Skin Tightening After Downsizing Surgery?

Question

I'm petite, 5'2" 103 lbs, and 34 B entire life. I had surgery in Feb 2009 to get back the volume I lost. My breast implants are 350cc mentor mod plus. I feel very big and uncomfortable with my look and out of proportion. I'm VERY anxious to downsize.  But to what? I feel the mod plus is very wide. But the narrower options have very high projections.   I'm considering 275cc mod plus. I'm afraid 300cc won't be small enough.  I hate to make another surgical mistake.  My biggest concerns are how do I know what size to choose? Is the skin likely to tighten?

Otto Joseph Placik, MD · Answer

I would tend to agree with your assessment. I don't think 300 cc implants would make a significant difference if you feel the 350 are too large.
Decreasing down to 275cc is not a major size change (roughly 2.5 ounces). I believe your skin will contract down nicely to accomodate the new implant, given the relatively short time since they were placed .

Jed H. Horowitz, MD, FACS · Answer

It is certainly feasible to #downsize to smaller implants and also alter the positioning; if possible. However, decreasing is size may also require a Breast #Lift to to #tighten loose skin, better optimize the end result. Any #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome.

Farbod Esmailian, MD · Answer

It is very unfortunate that you will be undergoing another surgery in less than a year to resolve a problem that should not happen.  Anyhow, I generally tell my patients that you need to decrease the size by about 100cc to really notice a difference. 
Now, it all depends on how your skin quality was before surgery.  If you had loose skin and the surgeon was trying to fill the skin up, you may have loose hanging skin after the fact, or your nipple/areola complex may be a bit on the low side.  If the skin was tight before your surgery then it should not be a big issue.
Good luck.

Richard Baxter, MD · Answer

Unfortunately there is no perfect method to predict in advance which size is going to be best in the long run. The problem with downsizing, as you have anticipated, relates to the skin being stretched and so it may need tightening. This would require a lift if that is the case. However, this isn't always needed, so your plastic surgeon should be able to give you some advice on that.
The other question relates to implant dimensions. It really doesn't need to be too complicated. First pick the size (volume) that you want, then the style (diameter and projection) will be determined according to the base diameter of your breasts. Again, this is something your surgeon should advise you on rather than you having to do it alone.

Sugene Kim, MD, FACS · Answer

There are several variables in determining implant size.  When recommending implant size for my patients, I consider the followings: 1) patients' anatomy (height, weight, chest width, chest height, amount of breast tissue) and 2) patients' desired look/goal.  Without knowing your chest measurement and breast tissue amount, I cannot give you any recommendation.  You should visit with board-certified plastic surgeon who will examine you.  Try implant sizers to get a rough estimate of the size you may want.  As you know, bra/cup size will vary depending on the brand.  Good luck with you.
	Dr. Sugene Kim

Gregory Sexton, MD · Answer

Like all surgeons, I will say you need to be seen to make those types of decisions. Having said that, dropping to 275cc will make a noticeable difference. As far as skin recovery is concerned, it will depend on genetics and age, As long as the nipple is above the fold you will probably be happy.

Tom J. Pousti, MD · Answer

The more breast surgery I do the more I realize that there is no correlation between the size of implant and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saiine/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size.

Much of the final “look” achieved after breast augmentation surgery  depends on several factors: 1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal. 2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant. 3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants. Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants. On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.

I hope this helps.

Steven Wallach, MD · Answer

Choosing the correct implants and especially for down sizing is something that is done in person during a physical exam.. As for the skin, again it would be hard to say.

Tracy Pfeifer, MD · Answer

Hi Bird16. I am sorry you are having this problem. For the sake of people who may read this answer to your question, please be sure and try on sizes in the office to make sure you are comfortable with size and the surgeon should measure your breast and chest width to make sure he/she chooses an implant that is the right size for you. How to choose correct size now? What cup size did you want to be and what cup size are you now? This can be a guideline to help you. In general, I have found that patients do not see an appreciable size change without decreasing the size by 150cc, minimum. You might be happier with a low profile implant, especially with your height. Implants with more projection generally feel "bigger" to patients. You need to have an in-depth discussion with your plastic surgeon about this. In my opinion 275cc might not be small enough for you.

Elan B. Singer, MD · Answer

While it is a good thing to be an informed patient and actively engaged in the sizing of breast implants, it is the surgeon's responsibility based on his/her expertise that determines final implant size.  There is simply no way to answer your question without a physical exam.  Downsizing may or may not require additional lifting procedures.  There are many factors that determine this (i.e. skin quality, size of breast implant, submuscular vs. subglandular implant position).  I recommend going in for a consultation with a board-certified plastic surgeon to find the answers to your questions.  Good luck!
Dr. Singer

Breast Implant Size and Skin Tightening After Downsizing Surgery?

Answers (14)

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