Best Approach for Downsizing Breast Implants? (photo)

Question

I have 700cc subpectoral mod+ silicone. Periareolar incision. Flat chested preop, no asymmetry. I have mild symmastia & bottoming out.I want smaller implants about 350-400cc. Best approach to accomplish a great result? A staged procedure of removing implants with symmastia/bottoming out repair, then re-implanting after 6-12 months? I am 24, 5"5 and 110 lbs, no kids and don't want a lift. Skin is in great shape. Hoping it would shrink up nicely if explanting then reimplanting later.

Gregory T. Lynam, MD · Answer

I agree with the other posts and your remarks that a staged approach is best. I think you have a 50% chance of needing a lift so keep that in mind. Overall, think you will be happier in the long run with a smaller more proportional size for your frame. Good Luck!

Daniel Barrett, MD · Answer

Dear guest12,it is hard to tell for sure without an examination. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jed H. Horowitz, MD, FACS · Answer

It is definitely possible 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. #BreastAugmentation without a #BreastLift is usually a mistake looked back on by many patients. Most breasts will look larger and more droopy.They will sag more and sooner because of the excess weight altering the longevity of the results. The shape will usually not be satisfactory and sometimes results with “Snoopy” breast or double bubble. .A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is the most suitable for #breasts which sag or droop (ptosis) as a result of development, aging, pregnancy, breast-feeding and weight loss . Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy.With both implant types there are choices when it comes to size, shape, and profile. The criteria best to suit you will be discussed in full detail at your breast augmentation consultation. Also, the right implant for the revision is contingent on shape of body and your desired outcome.Altogether, the surgery will create an elevated, more youthful breast contour. Also, the nipple and areolae of the desired size and correct heightmay also be addressed. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

Stuart A. Linder, MD, FACS · Answer

Downsizing with pocket tightening and possible breast lift will be required to make your breasts smaller and less hanging as well. This may require more than one procedure.

Gary M. Horndeski, MD · Answer

The best approach for you would be Mini Ultimate Breast Lift and removal of implants.  At surgery your breast tissue is reshaped and displaced medially and elevated to create the cleavage and the upper pole fullness you desire.  This could be done in 1 procedure or 2 if you would rather stage the procedures.  The advantage of doing 2 procedures would be that with the implants removed, your skin will shrink and regain it's tone.  In the 2nd surgery, less skin would need to be resected to create the desired shape and the Mini Ultimate Breast Lift performed.

	Best Wishes,

	Gary Horndeski, M.D.

Armando Soto, MD, FACS · Answer

Hi there-

	If your priority in pursuing revision of your outcome is to avoid a breast lift, I think that the stages approach you describe MAY help, by allowing your skin time to contract after removal of the large implants currently in place.

	On the other hand, it is important for you to understand that i tis possible that even with this approach, a lift will be necessary to achieve your goals of a youthful and firm breast, as 700cc implants are very large and your skin has been stretched by them to a significant degree.

Gerald Minniti, MD, FACS · Answer

Hello,

	I would be very surprised that your skin is 'in great shape' if you were flat chested preop and now have 700cc implants.  Your high resolution photos show little pink blood vessels in the skin of your breasts, indicating significant stretch injury.  As you have pointed out, you are also bottomed out and have mild symmastia.  I'd like to know where you nipples would lie with your arms at your side.  Your situation is not simple, unfortunately.

	Perhaps a staged approach (either surgical or in the office with a needle) is one way of seeing 'how things will shrink up', but your pockets will still be too close and too low, and that will need to be addressed in the subsequent operation. Please understand that there is no one that can predict with total success, and that once you go smaller, you may really need that lift, especially after correcting the lower pole of the pockets so that the smaller implants sit higher, supporting your already sagging nipples less.

	Best of luck!

Steve Laverson, MD, FACS · Answer

There is no absolute "best way" to manage your situation, in my opinion, because nobody can predict with certainty the outcome of a given procedure or series of procedures. My approach would be to explant, perform bilateral capsulorrhaphies diminishing the size of submuscular pocket and adjusting position to accommodate your new size. Depending on skin thickness, may supplement with acellular dermal matrix or fat grafting, but if highly cohesive gel implant is selected, unlikely this will be necessary (opinion subject to findings on examination). No reason to anticipate you would need breast lift (my opinion), and no reason for "symmastia and bottoming out repair" if you plan two stages. If the exchange is carefully planned and skillfully executed and still doesn't work out, you may need revision, but this could happen even if two stages are planned from the beginning.

Ary Krau, MD, FACS · Answer

There may be some benefit in doing this in two stages.  However, staying without implants for 4-6 months is usually not acceptable to  most patients.  I think a good result can be achieved in one stage where the implant is placed in a new pocket between your anterior capsule and the muscle. This will result in correcting your symmastia while at the same time closing the space from your previous implant.  

	     On another note, the use of a 700 cc moderate plus implant was way too wide for your dimensions.  With that volume a high profile implant should have been used.

George Marosan, MD · Answer

Thank you for the photos. Your current implants are out of proportion to the rest of your body. My preferred way of dealing with this problem is exactly what you proposed. Remove the implants (if it would have been saline, I prefer to deflate them), close down the medial pockets to correct the symmastia and allow your breast tissues to tighten up on their own. This will avoid further scars on your breasts with re-augmentation with smaller implants. The only down side is that you will be flat for 4-6 months. See a board certified plastic surgeon with experience in these types of problems. Good luck.

Best Approach for Downsizing Breast Implants? (photo)

Answers (15)

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