Can I expect good results - downsizing to 200cc with a lift? (Photos)

Question

BA with “donut lift” 8 years ago. I have never been happy with the results. Currently have 425cc mod+ mentor gel UTM. Looking to downsize to 200cc mentor gel with a lift. Should I expect good results?

Alejandro Nogueira, MD · Answer

Main advice: get a Wise pattern lift, do not get another periareolar one, you went already too far in periareolar skin removal, another go at it and the deformity can be irreversible, do get a proper Wise (anchor, inverted T) breast lift plus the desired implants, a good and recommendable choice.

Daniel Barrett, MD · Answer

Dear Mamaneedsalift,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

Yes, you should be able to achieve a good aesthetic outcome after downsizing, but you will likely require a full anchor or inverted 'T" type lift. Compromising the procedure will compromise the outcome.

Michelle Zweifler, MD · Answer

Often when downsizing breast implants, patients benefit from a breast lift.  Most commonly an anchor/inverted T incision to improve the natural breast shape.
The "donut lift" frequently results in enlarged areolar (pigmented portion) and/or wide scars.

Gerald Minniti, MD, FACS · Answer

The donut lift was the wrong lift for you nearly a decade ago even with a relatively large implant, and that's why you were never really happy. Downsizing implants now would create an even worse situation. You need a formal breast lift. Even with the scars you will be very happy with the result (assuming you go to a true breast surgery expert.)

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I have been in practice for over 30 years and revisionary breast surgery is a large portion of my practice. I have performed surgery on thousands of cases similar to yours wanting to be smaller with more upper pole fullness. I have developed with a technique termed "reductive augmentation" which I published in 2017.  It involves perform an internal bra/capsulorrhaphy, reaugmentation with a smaller ultra high-profile implant, removal of inferior pole breast tissue, and revision of your mastopexy/lift. You should be able to have an excellent result. Best wishes to you.

Gary M. Horndeski, MD · Answer

Your breasts are wider than your chest wall and are located low on the chest wall. I would recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. I would caution you to have a more detailed conversation with your surgeon about your goals. What it appears to me in the pictures is that the majority of your problem is due to heavy natural glandular tissue that needs to be reduced. Often with cases like yours, patients assume they need to downsize the implants, but what they really need to do is downsize the natural breast. So I would say that you might not want to downsize from 425 to 200 cc unless the implant and the placement and size of the implant is really the problem. You also need to proceed with an aggressive mastopexy (anchor-type lift) for optimal results. 
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Harry T. Haramis, MD, FACS · Answer

Usually a much smaller implant will cause the breast and skin to droop. So a full T lift will make the breasts perkier.

There will be less upper fullness with a smaller implant but the combination should give you smaller, higher, perkier breasts- if that’s what your goals are.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Georgina Nichols, MD · Answer

Hi there! Thank you so much for your question and for sharing this here.
I’m sorry to hear you were never fully happy with your prior result. One of the most important parts of revision breast surgery is ensuring that you and your surgeon are fully aligned on goals and expectations. Be sure to communicate what you’d like in terms of size, shape, areola position, and overall look. Bringing “wish photos” that reflect your body and breast type can be very helpful for this discussion.
From what you describe, downsizing your implant size and combining it with a breast lift is a sound plan if your goal is smaller look. Going from 425cc to 200cc should help achieve a smaller, perkier, and less top-heavy appearance. 
The key will be careful surgical planning to manage your existing tissue, implant pocket, and skin envelope &mdash; so your results align with your goals. Having a clear discussion with your surgeons about your goals and expectations is paramount. 
Every patient is unique &mdash; anatomy, history, physical exam, tissue quality, goals, skin elasticity, and surgical risk profile all change what is indicated/recommended. Because of this, this should not be taken as personal medical advice. The next step is always an in-person evaluation with a board-certified plastic surgeon that can examine you and discuss individualized plan options.
Hope this helps!
&mdash; Georgina Nichols, MD, FACS

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