Best method for downsizing breast implants? What happens to the scar tissue/capsule thats formed around the 1st implant?

The
best method for downsizing implants depends on the patient’s desires.  Unfortunately, you have not told us your bra
size or provided photographs.  The
technique I usually recommend is explantation using The Bellesoma Method.  The implants are removed, your breast tissue
is reshaped creating upper pole fulleness, elevated higher on the chest wall
and more medial to increase your cleavage. 
Vertical scars are avoided, nipple sensation and the ability to breast
feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can
be performed if additional volume is desired. 
At the time of surgery, the capsule may or may not be removed depending
on the surgeon’s discretion.  Implants
are not lifetime devices and half are removed by 9.5 years.  Fat transfer is preferred to small implants.Best Wishes,Gary Horndeski, M.D.

Hello,Implant malposition leading to dropout or lateral displacement can be due to many factors: the creation of a pocket too large, or in a way that destabilizes the surrounding tissues (blunt dissection), the use of smooth implants, the use of 'very large' implants (no official designation for what size implants these constitute), the use of saline implants, and the use of implants that were objectively too large for the patients anatomy.  The repair of this depends on what factors were implicated and the degree and direction of malposition. Either capsulorrhaphy is performed (most commonly), or the creation of a neo-subpectoral pocket. Scar capsule is usually not removed for implant malposition. More important than the chosen technique is the surgeon executing the procedure. The best chance of a successful outcome is by choosing an ABPS certified/ASAPS member surgeon who specializes in revision breast surgery and has at least a decade of experience doing revisions on a regular basis. Best of luck!

You can definitely downsize your implants at any time. If the pockets stretch (which they usually do over time), then downsizing to a smaller implant usually requires a capsulorrhaphy - internal tightening of the pocket to make the pocket smaller. This is usually done to the lateral and sometimes inferior pocket. As for removing the capsule, it depends on how thick the capsule is over time. If it's thin, then it's usually left in place. The capsule can help support the internal tightening. Lastly, often a lift is needed to give better shape to a smaller implant and breast.

Dear jmhig218,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

Its difficult to answer your questions without some photos. For downsizing, sometimes its as simple as placing smaller implants while other patients with stretched skin or very large implants will require a lift and possibly mesh support. the capsule can stay or be removed

Thank you the question but online consultants will not be of much specific help to you.  Keep in mind as you are thinking about your goals that sometimes adjustment of the breast implant pockets (capsule adjustments) and/or breast lifting may be necessary to achieve the outcome you are looking for.   Whether or not the adjustment of the breast implant capsules and/or breast lifting will be necessary will mainly be dependent on your physical examination; specifically, factors such as the amount of redundant skin, quality of skin elasticity,  and how much you downsize will be important.  
In other words, there may be other variables involved, besides just breast implant volume, that come into play when it comes to achieving the desired aesthetic outcome.
Generally speaking, the best online advice I can give to ladies who are considering revisionary (downsizing) breast augmentation surgery is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
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 "down a cup size” or "C or D cup" or "significant change" etc 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. 
3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.
I hope this helps. Best wishes.  
 

Thank you for the question and I would go on some complimentary consultations with experts and compare recommendations after a full examination and become fully informed about the desired procedure 
Dr Corbin

In general, if the original implants are properly positioned and weren't too large or wide and stretched or distorted the tissues around the breast, downsizing means lowering the forward volume (projection) of the implant and keeping the width of the implant the same. If it was a high profile implant then the old one can simply be taken out and one of moderate profile (same width) can be placed and lose about a half cup of breast size relative to the same chest circumference. If the original implant was a medium profile then it can be changed to a low profile implant (same width) for another half cup size decrease. The capsule around the implant doesn't really know anything's changed. It's just a smaller forward-volume pillow. If the existing implants are malpositioned or there's a capsule problem such as stretching then adjustments would need to be made in the capsule space and the width of the implant might need to be changed along with that on the other side. Basically for proper fitting, the width of the implant should match the base width of the breast (minus about a cm for the skin/fat layer) and the forward volume of the implant (projection) can be chosen among at least three options of low, medium, and high profile implants. (There is also one between medium and high profile). The difference in low, medium, and high profile is roughly a half cup of apparent size unless the breast is unusually wide or narrow for the chest circumference. 

Dear Jmhig218,Hello and thank you for your excellent question.  This is a very difficult question to answer without a face to face evaluation. One option is to be evaluated for a No-Vertical-Scar breast lift technique.  Some people refer to this as the Bellesoma Breast Lift technique. Our technique provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. Finally, for patients who desire breast enlargement, it can be combined with fat grafting. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 - 2018