Best Approach for Downsizing Breast Implants? (photo)

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.

Doctor Answers 13

Breast implant reduction in size

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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!


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     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.


Best Approach for Downsizing Breast Implants? (photo)

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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.  

Breast implant revision

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This is a tough situation because removing the implants and say exchanging for those 1/2 the size may require a lift to deal with the loose skin. If you remove the implants, then you will have to wait several months to have new ones placed, and there is no guarantee how the breasts will look when the implants are removed other than that they will be deflated. But they may also scar down.

Breast Revision to Include Smaller Implants

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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.


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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. 

The degree of skin/tissue resiliency/contraction that will occur intraop is the main variable.

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 Thus, it may be sensible to allow your surgeon to make the choice between one or 2 stages at that time. Without any question, the use of Strattice is an important adjunct, but I would place it only during the same operation in which the new implants are to be placed. The use of that product makes the choice of pocket location less critical.

Todd Sisto, MD
Pittsburgh Plastic Surgeon

Staging of Breast Implant Revision

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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.


Best Approach for Downsizing Breast Implants?

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I would replace the smaller implants in a subfascial pocket and use ACD or mesh to support the glandular tissue

Staged procedure is the best approach

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The only way to possibly avoid lift is to give time for your tissue to heal and retract. I routinely do deflation for saline implants before revision surgery. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.