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

I currently have 400ccs sils under -diam.13.1/4.0 proj. Im much larger than I want so I want to downsize with capsullorhaphy & no lift. My surgeon is going to waive fee, but he wants me to decide on size, he doesnt want to be responsible for me not liking the outcome again. I attached some photos of my goals, preop and current. I want allergan saline low profile. What should I choose? 170cc(9.9/3.2) 195cc(10.4/3.3) 220cc(10.9/3.4). I want to be small again. I heard u can go too small an look bad

Doctor Answers 12

Need Help Picking a Size to Downsize Implants

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.

Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Picking best Breast Implant when going smaller

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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Downsizing implants

Downsizing can be difficult for two reasons. 1) it can be difficult to get the size right for the patient's taste. 2) and they  might need a lift since the tissues are already stretched out.  It is best to help determine this in person

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

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

Choosing the correct size is one of the most complicate dissues in breast implant surgery

If you have decided on saline implants , I would recommend the Saline Adjustable implant .This will allow you to change the size after surgery

Unfortunately the adjustable gel implant is only available outside the USA

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Implant Size When Downsizing?

Downsizing can be a challenging process as there are many varialbles and it is important to recognize that you might be able to get exactly what you want.

Looking at your before/after photos it appears that your original implant was oversized for both your breast dimensions and the width of your chest. The implant used appears exceptionally wide for your chest, but now your skin is stretched out and the internal implant pocket is large to accomodate the wide implant. 

Downsizing will require capsulloraphy as you noted, but the skin must also retract significantly so it doesn't appear too loose on a much smaller implant. Fortunately you appear to have very nice elastic skin. You might consider the option of percutaneous deflation of your saline implant several months before doing the exchange. This will allow for maximal skin retraction before putting in a new implant. I doubt you will be able to downsize as much as you specified. Something in the 250-275 range will be more likely be needed to adequately fill the skin envelope. Deflating before the exchange might allow for better assesment of your residual breast dimensions and provide a better guide as to which new implant to choose. I don't think a textured gel implant offers any particular advantages in this type of situation.

Braden C. Stridde, MD
Kirkland Plastic Surgeon
4.8 out of 5 stars 53 reviews

Smaller implant exchange

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. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.8 out of 5 stars 95 reviews

Downsizing your breast implants

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.

Matthew Schulman, MD
New York Plastic Surgeon
4.9 out of 5 stars 326 reviews

Best Breast Implants For Me (Downsizing)?

Thank you for the question and pictures.

Despite understanding your situation, I still think your plastic surgeon  is your best resource in guiding you in regards to the best breast implant size/profile to meet your goals. After all, he knows you and your goals better than any online consultant can.

 Having said that, after reviewing your pictures, I think you may do very well with breast implants in the mid 200 mL  range. Going smaller may leave you with loose skin; larger breast implants will not achieve your goals of  significantly smaller breasts.

 I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Breast implant revision surgery

Looking at  your post op photos and your goal photos it appears that you are about 2 cup sizes larger than desired.  Most of the implants that I use are in the 300 to 400 cc range.   The difference between these two is 100 cc or in most individuals about 1/2 of a cup size difference.  In anticipation of you seeking a smaller size you should first consider the base diameter of the new implant.  Your current photo shows implants that are full superiorly and extend out laterally pas the lateral rib cage.  If your desire is to go down a full cup size then an implant in the 200 cc range, low profile should be closed to your desired result.  If there is a significant difference in the base diameter then you would need a capsulopexy at the same time.  Additional information is needed about how long ago you had the initial breast augmentation and what degree of superior pole fullness is acceptable to you.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews


It is important to know how long you have had the implants because, if the augment was recent, you are more likely to be able to go smaller without needing the lift. I prefer moderate profile implants particularly as you had some flattening of the upper poles to begin with. I think you need to define for us what you mean by "small" because I have concerns that if you go down to the 170-200 cc range, you may be disappointed in the shape of the breasts.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

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.