Need Help Picking a Size to Downsize my Implants? (photo)

Breast revision surgery is more difficult, complicated, and requires more time than primary surgery. There is as much as a 40% chance additional surgery will be needed following the #revision. As far as sizing, there are no promise or guarantee of the specific cup/bra #size and shape you will be after your surgery.  Implants which are under the muscle or are placed in a new position under the muscle may change with shape on muscle contracture and may have “#banding” and motion of the implants with muscle contracture. If this is unsatisfactory, it may require additional surgery which will also require additional surgeon’s fees, operating room and anesthetic fees.

You are right, going smaller may lead to changes including lack of fullness and sagging. It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon

If you feel that you want to downsize your implants, it is certainly a feasible option.  I would narrow the new implant size to somewhere between 300 and 400.  However, the ultimate choice really depends on your personal aesthetic.  

It's best to discuss and collaborate with your surgeon regarding your new size. I would recommend at least a 100cc downsize and change to the new Sientra shaped textured round base silicone implants. I think these implants are especially suited for patients who are borderline needing a lift as part of the downsizing implant exchange. Please discuss this potential option with your surgeon. Breast of luck. 

If I understand you correctly, you currently have 400cc and want to downsize to the 170-200 range without a lift. I think that if you go too small, then you will have skin laxity and droop that will be a problem for you. The solution is to go slightly larger in the range of 200-275 or go small but also have a lift.  I am not sure that low profile is the right choice for you but without examining you, I cannot be sure.  You plastic surgeon should be involved in the size selection. Clearly he wants you to make the final decision, but he needs to guide you. I think he doesn't want to pick the size because you were unhappy with his size selection in the first surgery and now he has to re-do it and waive his fees, despite the fact that his is spending time and assuming the liability for your second surgery.