One Operation for Downsizing Implants and Lift?

I am currently a 36DD with 425 high profile filled to 480cc's. I had staged breast lift and augmentation. I want to go with much smaller implants and will need a lift but my surgeon will not do it all together. He says I will have to undergo 3 separate surgeries to achieve what I want because the risks are too large. I don't want to go through all this surgery. I have found another surgeon who will perform it in one stage, and says it's safe. Now, I don't know what to do! Any advice?

Doctor Answers 6

Lift and implant exchange

Switching implants to a smaller size may require a lift. This can definitely be done in one stage although as you have experienced some like to stage them to see how the skin redrapes around the smaller implant first.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Usually no problem to do it in one stage, but pick your surgeon carefully

In general, an implant downsizing with a lift can indeed be done in one stage, as long as you are otherwise healthy and have no inherent risks for bad healing (smoking, diabetes, etc). This type of surgery, however, requires a qualified plastic surgeon who understands the pitfalls and risks, so that he can avoid them and give you the results you want.

In terms of 3 procedures, I'm not sure why all 3 would be needed (I suppose some folks would do this in 2 procedures, but again I think in most cases it can be done as one case).

Good luck!

Dr. Salemy

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 149 reviews

Doing it in one stage depends on both the surgeon and the breast

I am assuming that your breasts are not that droopy, since you already had a lift procedure. In this case, a downsizing and lift can usually be performed simultaneously, especially in a non-smoker. It sounds like your first surgeon is just ultra-cautious from a bad prior experience, perhaps a nipple had poor blood flow and died on a previous patient.

I agree that surgeons should work within their comfort level. Find someone with lots of experience and great results achieved long term. Always avoid surgeons that go too big to get the effect of a lift from the implant -- in the long run your breasts will droop and you will be unhappy.

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 13 reviews

Can be doen in one step in most but not all cases

Downsizing implants and a lift can usually be done in one operation but there are problems that can only be determined at the time of an examination.

  • Are the implants above or below the muscle
  • Do you have a capsular contracture
  • Are you a smoker
  • What is your age
  • is the skin and breast tissue over the implant thinned and stretched

All of these can effect your healing and thus your result. If your breasts are soft, there is no capsular contracture, your are not a smoker and there is adequate thickness of soft tissue over the implant it can be done in one step. It is important to centralize the nipple and areola directly over the center of the implant. This may require a modification of the breast lift design to achieve this result.

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

Usually this can be done in one procedure

Implant downsizing and a lift are almost always done in one operation in my practice.  As long as you are not a smoker, and are otherwise healthy and have had only one previous operation, I would do it in one stage.  3 stages seems extreme to me and I can't really understand that plan.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Trust whomever you go to

Each doctor has his or her own level of confidence in a procedure and his or her own level of risk tolerance. Downsizing an implant is simpler than the original augmentation. The dissection has already been done and the pressure on the tissue will be less rather than greater. Ask each why they believe what they are recommending. Three stages sounds extreme. I have usually performed both at the same time particularly if the implant is submuscular. However, it also depends on how the lift is performed. I would be more concerned about finding information about the original lift and how it was performed since doing a secondary lift can compromise the blood supply to the nipple with certain techniques.

Your surgeon should also explain his surgical priorities and his bail-out procedure in case something looks wrong. That is, is he going to do the implant exchange first or after the lift. Also, if the nipple looks compromised or turns white or purple, what is his plan? Does he just do one stage and leave the other for another day. Will he take the nipple off as a graft? Will he complete the procedure and start hyperbaric oxygen therapy? A good surgeon will have contingency plans in complex cases. We don't worry when things go right, we worry when things go wrong. Are either surgeons capable of handling these problems?

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 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.