Thank you for your question. I have read some of the physician responses here but I have not seen anyone recommend deflation of your current implants in preparation for the exchange procedure. The fact that you have saline implants works in your favor in this case. Saline implants can be ruptured in a controlled setting in the office. Doing so will allow your breast skin and capsule to contract and potentially significantly limit the work that needs to be done in the operating room and improve your result. In addition, once the implants have completely deflated, you can be resized in the office for your new implants rather than you and/or your surgeon guessing how small of an implant will make you happy. You would still be able to have the surgery performed through your existing incision/scar. Using this method, little to no capsule work or raising of the crease may be necessary. And, you would most likely not require any tightening of the skin (or lift). Do your homework in finding the right board certified plastic surgeon to get the result you are looking for.
Thank you for your interesting question. I do believe that to your pocket will have to be adjusted to accommodate a smaller implant, according to how much smaller you plan to go. But for a B cup you will need to reduce to about a 350 ml implant.
The problem for your plastic surgeon will be to maintain fullness in the upper portion of your breast and to reduce the lateral pocket so that you still have the adequate cleavage. To do this, the inframammary crease will probably have to be elevated.
I can't tell exactly where your incision is from your photographs, but I would suggest using an inframammary incision which will make necessary adjustments easier.
Good luck with your procedure.
Based on your pictures, you do not appear to need a breast lift. I don't believe this will change as you go to a smaller volume implant. There may need to be some adjustments made to your pocket in order to accommodate the smaller implants. This could all be done through your previous incision. I would suggest that you schedule a consultation with a board-certified plastic surgeon who can evaluate you in person and review your options with you.
Your situation is a complicated one. You will need the pocket made smaller to raise the fold and reduce the lateral displacement in order to maintain the cleavage and upper pole fullness. Discuss this thoroughly with your PS prior to surgery. Take your time in choosing a surgeon. Good Luck.
I am sorry to hear about your dissatisfaction after breast surgery. Your question is a very good one; however, whether or not removal/replacement alone will achieve your goals is hard to know without physical examination and a complete communication of your goals. Sometimes, additional work such as “capsule work” (capsulorraphy) is necessary to improve the outcome of surgery when patients undergo downsizing of breast implants. Also, there are cases where patients benefit from removal of skin (breast lifting) along with downsizing of breast implants. Much will depend on how much you downsize, the position of your current breast implants on your chest wall, and the quality of the overlying skin/tissue elasticity.
Please make sure that your plastic surgeon has a significant/demonstrable experience with revisionary breast surgery. Make sure that you communicate your goals carefully as well. I ask for patients to provide "goal photos" because sometimes stating that you want to be "a full B cup" may mean different things to different people.
Working together, you will come up with the best plan to achieve your goals. You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you as you consider options. Best wishes.