Implant exchange only or will I need a lift? (Photos)

Question

20 year old implants, feeling heavy and out of shape (From memory they are 300cc silicone) No issues with them just looking for something smaller. Considering 235cc low profile motiva to get rid of the upper pole fullness which i don’t like, and add width / bring them closer together as i have quite broad chest. I really hope to avoid a lift as i dont want the scars but will it be necessary?

Kelly Schultz, MD · Answer

Thank you for your question! Based on your nipple position in the photos you provided and the amount you are hoping to downsize, I would likely recommend a breast lift along with your implant exchange. After having implants for 20 years, your skin and breast tissue have stretched to accommodate them, and placing a significantly smaller implant can sometimes make existing droop more noticeable. A lift can also reshape and tighten the breast envelope, which may give the breasts a narrower, more compact appearance.
That being said, a lift is not necessarily your only option! If avoiding scars is very important to you, downsizing alone may still be reasonable as long as you are comfortable with some residual sagging.
I also love that you are thinking about implant profile rather than just size. A lower-profile implant may help reduce the upper-pole fullness you dislike, but the exact width and profile should be chosen based on your breast and chest measurements. Your natural anatomy also determines how close together your breasts can safely sit.
I would discuss both options with your plastic surgeon so you can decide which tradeoff (additional scars versus breast shape) feels right for you. Wishing you the best of luck!

Mert Demirel, MD · Answer

With 20-year-old implants, an exchange is reasonable to consider, especially if they feel heavy or the shape no longer suits you. Going from about 300 cc to 235 cc can reduce upper pole fullness, but it may also reveal more natural breast looseness once the larger implant is removed.
A low-profile implant can give a softer, less projected look, but it will not necessarily bring the breasts closer together. Cleavage and spacing depend mostly on your chest anatomy, implant pocket, breast footprint, and where your natural breasts sit. A wider implant can help fill the base, but it cannot safely move the breasts beyond their natural limits.
Whether you need a lift depends on nipple position, skin quality, and how the breast tissue sits after downsizing. If the nipples are still well positioned and the skin envelope is not too loose, implant exchange alone may be enough. If the nipples sit low or the lower breast skin hangs, a lift will give a more controlled shape.
Trying to avoid lift scars is understandable, but using implant size or width to avoid a lift can lead to a heavy or low-looking breast again. If the skin has stretched over 20 years, a smaller implant may look more natural but also less supported.
My advice would be to ask your surgeon to evaluate you with the implants removed or compressed during exam, if possible, and show where the nipple sits relative to the fold. If your main goal is smaller, softer, and less upper fullness, 235 cc low profile may be reasonable, but a lift should remain part of the discussion if the skin envelope cannot support the new shape.

Gary M. Horndeski, MD · Answer

Your breasts are asymmetrical, one nipple-areola complex is higher than the other and the folds are at different positions. You will need the implant pockets redone in such a manner to make them symmetrical. You may also benefit from a donut mastopexy to re-position the nipple-areola complexes to make them symmetrical as well.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Shlomo Widder, MD · Answer

Dear Virginian,
   Thanks for posting your pictures. From observing your pictures you appear to be C cup or small C cup size with moderate capsule (pocket scar) contracture and mild ptosis (droopiness). Replacing your implants from 300 cc to 235 cc will reduce you breasts size by about 1/2 size and reduce your upper pole fullness. Capsulotomy (scar release) will improve on it further and will soften the breasts as well as improve on your cleavage. Finally, a mini lift ( donut lift, purse string lift) will give you a more youthful appearance and improve on your cleavage with excellent scarring as the scar will be place at the areola border which make it a natural line.
    Always consult wit experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the pictures at the  photo gallery of redo breasts augmentation with mini lift to make sure that they are numerous, consistent and attractive with nice cleavage, nice projection, nice scars and natural upper slope and breasts look.
              Best of luck,
                                      Dr Widder
                           widderplasticsurgery.com

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, you have significant breast asymmetry,  some capsular contracture (implants create superior pole fullness) and sagging breast tissue off the implants inferiorly. I understand your concerns about additional scarring, but to get the best shape with smaller implants as well, a lift is highly recommended. Removal of 20+ years old implants can be challenging if they are textured and or broken. We do not like to have surprises in the operating room, so imaging studies might be needed prior to your surgery. At times, these need to be staged, implant removal and a lift, followed by an augmentation later for best long term results. Along with the implant exchange/lift I would recommend liposuction of the axillary fullness and lateral chest wall. See a board certified plastic surgeon for an in person consultation evaluation. Good luck.

Yasemin Aydinli, MD · Answer

Thank you for sharing your photos. There is visible sagging in your breasts, and since you are planning a smaller implant, exchange alone will unfortunately not give a good result. Another important point is that after 20 years it is often advisable to remove the capsule around the implant as well. The capsule acts almost like an internal support holding the tissue together, so once the implant and capsule are removed the overlying skin usually looks even looser than before. This makes a lift even more necessary, especially when a smaller implant is being placed. In addition, if your current implants are above the muscle, moving the new ones under the muscle would be a more sensible choice. These decisions should be confirmed by physical examination.

Laura Roider, MD · Answer

@PL2085 thank you for including photos. It allows me to provide custom recommendations. Typically, when downsizing an implant you need to consider a lift. Based on the information you shared, I anticipate you will need a vertical lift (likely lollipop scar pattern) to address the pseudoptosis (breast tissue hanging below your breast fold) you have in the photos. Additionally, when downsizing implants you'll need either extensive capsule work or a plane change to control the position of an implant.

Luis A. Mejia, MD · Answer

Thank you for your question, Downsizing from 300cc to 235cc after carrying implants for 20 years will almost certainly require a skin lift (mastopexy) or extensive internal pocket tightening to avoid a saggy, empty, or drooping outcome., for more information contact us 829-745-2440.
Dr. Luis Mejia
Let's make it better

Camille Cash, MD · Answer

From the photos it appears you have breast asymmetry and some looseness of the skin.  Since you are planning to downsize a lift is likely recommended which can address both the asymmetry and looseness of skin.  The result will be a much more in line with the look you are wanting.  The full anchor lift may not be necessary.  Visit with a board certified plastic surgeon near you to learn more.

Implant exchange only or will I need a lift? (Photos)

Answers (9)

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