Does the Breast Implant Pocket Shrink?

Question

I had 425cc breast implants replaced with 300cc. Will the pocket made behind my pectoral muscle deacrese in size to accomodate new smaller implant? It feels a little empty.

Otto Joseph Placik, MD · Answer

The capsule will likely shrink a small amount but there are many different aspects to the breast capsule other than the volume. The diameter and projection of you new implant play a role as does the surface texture.
More often than not some amount of capsule repair is required and is called a capsulorrhaphy. Usually this is done to keep implants from falling to the outside of the pocket.
If this was not performed at the time of your procedrue, you may want to consider wearing a supportive bra while the capsule shrinks down in order to avoid outward movement of the implant during this time period. I often suggest that patients wear these 24 x7 for 6 weeks during the post-operative period. In any event discuss this with your surgeon.

David Rankin, MD · Answer

There may be some contraction of the pocket after a smaller implant is placed, however, sometimes it is necessary to place some sutures at the time of surgery to reduce the size. Otherwise, your implants may be felt moving around inside the pocket. Give this some time (a few months) and talk with your surgeon to see if sutures were placed to close the pocket at the time of surgery.

David A. Robinson, MD · Answer

When an initial breast augmentation surgery is performed, a capsule made of scar tissue develops around the implant.  This initial capsule may shrink causing a tightness or distortion of the breast called a capsular contracture, which may need to be addressed by your surgeon.
Routinely, after the capsule has formed and stabilized over time, it will not continue to shrink.  If a larger implant is replaced with a smaller one, the capsule does not appreciably shrink to conform to the new size of the implant.  This will usually result in the pocket being to large for the new implant therefore causing the implant to move within the pocket and migrate laterally.  This can be prevented if the surgeon decreases the size of the capsule (performs a capsulorraphy) prior to placing the new smaller implant. 
If the capsullororraphy is not performed at the time of the implant exchange, the chances the pocket will shrink enough on its own to accomodate the new smaller implant are not very good.

Christopher L. Hess, MD · Answer

The pocket is make by the capsule with is a fibrous structure. When larger implants are replaced by smaller ones the capsule size stays the same. So the surgeon must plicate or suture the pocket to itself to make it smaller. This way the new implant won't move around in the larger pocket.

John P. Stratis, MD · Answer

Whenever an implant is completely removed or replaced with a smaller implant there is less volume. The skin, breast tissue and the capsule cavity(or space for the implant) may shrink down to the new size. Sometimes only one of these components wil decrease in size, sometimes non of the complonents will shrink and sometimes they all shrink.
I would advise waiting 6 months to see what happens to each of the components and then  determine if anything additional needs to be done.
Very often when there is a size change downward or complete removal of the implant surgical reduction of the stretched-out tissue will be done at the same time. If an implant size has been decreased it can also be pleced at a different level, not exactly in the same space as the old larger implant. Under those circumstances you don't have to worry about the old site because the new implant is no longer in that space.

Nina S. Naidu, MD, FACS · Answer

Hi,
You will have a small amount of natural contraction of the tissues after having had your implants downsized.  However, the amount of contraction is dependent upon a number of different variables, including the elasticity of your own tissues, your age, and whether or not your surgeon closed down the old implant pocket with any stiches.  In some cases, a small amount of fluid may fill that empty space, but this should resolve on its own within several weeks.  I would recommend asking your surgeon about your "empty feeling" at your next office visit if it hasn't resolved by then.  Good luck and best wishes.

Michael C. Edwards, MD, FACS · Answer

This is one of the problems with downsizing implants. If the pocket isn't modified by suturing some of it closed, called plicating, the capsule will allow the implant to move in different directions such as farther down while you are standing up or too far to the side when laying down. This is what is creating the empty feeling.
Dr Edwards

Francisco Canales, MD · Answer

In general, reducing the implant by 125 cc like you had done, will leave a smaller implant to float around the previous pocket. The pocket may contract somewhat, but it is unpredictable. Aesthetically, we try to make a judgment during surgery. If we feel the implant slides too far laterally or inferiorly we prefer to correct the pocket at the same time by using some sutures.  
However, if we feel that the implant aesthetics are still adequate with the smaller implant, then we simply switch out the implant.  Give it about 3 months and re-evaluate with your doctor.

Robin T.W. Yuan, MD · Answer

When an implant is placed behind the muscle, the back of the capsule that forms is attached to the ribs. Because of this, that portion of the capsule cannot contract as well as the front of the capsule that is attached to mobile soft tissues. This maybe one reason why submuscular implants have a lower incidence of capsular contracture. Also, unless you stimulate the capsule by some injury, it might not have any thing to initiate the shrink or contracting process. The volume of the replaced implant may not be as important as the width in this situation and your surgeon can answer the question of whether or not it is beneficial for the pocket to shrink.

Robert T. Buchanan, MD (retired) · Answer

An old implant capsule (the scar tissue forming the pocket) can shrink if left in place when implants are exchanged. Usually, however, the capsule or a part of it is removed in order to position the new implant properly. The looseness that you feel may be the extra skin you have if a mastopexy (lift) was not done at the time of the exchange. This will frequently resolve, depending on your age and the elasticity of your skin, as the tissues shrink. The best way to get an answer to questions like this is to talk to your surgeon. He/she evaluated your tissues and knows what was done at the time of surgery. Their answer can, therefore be more specific.

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