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.  

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.

I really believe you are making a poor decision but it is yours to make. Use HP saline in 300 cc range. Please reconsider the nice result you have 

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

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

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. 

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.

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.