Breast Implant Revision with a Smaller Profile?

i had a subfascial breast augmentation with 295cc extra high profile implants. (12cm dia, 5.4cm projection) What i wanted before the surgery was to have a lowprofile implant. Now i am considering having a revision with an implant of same diameter and low profile. (around 225cc) But my doctor says with a low profile peardrop implant, it will definitely turn around inside my body, because of larger pocket. When i suggested a pocket revision, he said there is no concept like that. What should i do?

Doctor Answers 11

Smaller Implant and Concern for Rotation

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   An anatomic implant can rotate.  However, a different pocket can be made in a different plane or the same pocket can be revised.  The implant can be changed to a round implant to eliminate the rotation issue.

Breast Implant Revision with a Smaller Profile?

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I think you request is completely reasonable. Although it is possible that the new implant would flip, it is unlikely with an implant so close in size and dimension.

Furthermore, there are at least three pocket choices that would avoid that risk.

  • Move to subglandular, above the muscle and fascia
  • Move to subpectoral, under the muscle
  • Move to "neopocket,"  placing the implant under the current periprosthetic capsule (the capsule your body has formed around the implant) and that way the implant is under the fascia and the extra layer of capsule.

For any of these, the new pocket would be dissected to the proper size there should be the usual extremely low rate of implant flipping. Thanks, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Implant Exchange with Mini Ultimate Breast Lift

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The difference between a high profile and a low profile implant is usually about a centimeter (about 1/3 of an inch).  However, the difference between a 295 and 225 is about 1 cup size if you are size 32 or 34.  If you are worried about the implant rotating, I recommend round implants instead of anatomical.  If your breasts are hanging now and you add an implant, they will hang even more.  I recommend a circumareola lift procedure instead of a lollipop, which results in a vertical scar.  You may be an excellent candidate for a new technique called Implant Exchnage wiht Mini Ultimate Breast Lift.  By using only a circumareola incision it is possible to exchange your implants, plicate the capsule if needed, reshape the breast to create upper pole fullness, increase cleavage and elevate your breast.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

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Breast Implant Revision

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Thanks for posting the question.  The details of your situation are not entirely clear, such as why the difference in profile implant chosen in the original surgery, but I strongly recommend you get at least one other opinion, and only from a Board Certified Plastic Surgeon.  Be especially cautious with anatomic shaped implants as they have the potential to rotate, whereas this is a non-issue with round implants.  Best wishes!

Brian Howard, MD (retired)
Alpharetta Plastic Surgeon

Replacement of breast implants with smaller profile

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This is another example of knowing what implant will fit, look natural, and what effect it will have for the first surgery. Replacement or revision is common enough that this should be considered for the original procedure. It is fairly easy to increase or decrease the profile of round implants, but not shaped implants. 

There are essentially three profile choices for round breast implants. The vast majority of cosmetic augmentations can be done appropriately with round implants that are properly fitted and positioned and in one of the three profiles (low, medium, high -- not called that in gels) with the same diameter that fits the width of the breast. If you had the highest profile round implant and the width was appropriate, you could downsize to a medium or low (forward volume) profile with the same width using a simple exchange procedure. 

It is very difficult to downsize the capsule width on the medial or lateral side. Techniques exist for this but they are not simple or inexpensive. 

I would recommend going with a round implant of the same width as your shaped one but with a lower forward profile. This should accomplish what you're looking for without complicated surgical maneuvers. An exam and specifics of the existing implant would be essential. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Implant revision with smaller implant

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Personally I do not like the teardrop shaped implants because they can turn.  But certianly it is possible to go with a smaller implant.  It is best to be evaluated in person.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

BA Revision??

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 Please..., you need a second option. Consider obtaining your operative report from your breast surgeon. Then, look for a local member of the ASAPS in your area. There are expeterts in revisional breast surgery. Best,


Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

Breast Revision to Include Smaller Implants

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It is certainly feasible to #downsize to smaller implants and also alter the positioning; if possible. However, decreasing is size may also require a Breast #Lift to to #tighten loose skin, better optimize the end result. Any #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

#BreastImplantRevision Profile Change

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It is possible to both reduce the pocket size (capsulorraphy) , use textured implants (sort of like velcro) as well as make a new pocket to decrease potential for rotation. You might want to have a second opinion by a plastic surgeon experienced in secondary breast implant revisions. See below link for how to do this. 

What to know about downsizing implants

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No one can give you definitive advice without seeing you personally and knowing a few details, for example why did you not get the implants you wanted the first time? If you go with round implants then rotation is not an issue. The shaped implants (teardrop, anaatomic, form-stable, gummy bear) are suitable for a relatively small percentage of augmentation patients because of issue such as rotation and firmness.Round implants BTW also have a teardrop profile in the upright position.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 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.