Downsizing for Large Implants and Saggy Breasts?

I had 330 cc's saline, McGhan, textured, anatomical implants for 12 years. This made me a small 32 C. I had them replaced 2 years ago. My breast size became 32 DD and was too wide for my frame. My doctor put in 475 cc filled to 540 cc, Mentor, round, saline. I am 5'3, 120 lbs. Prior to having these implants put in 2 years ago, my breasts were perky. These heavy implants have pulled them south. What are my options for downsizing?

Doctor Answers 10

Too large implants with droopiness

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At this point, your best option is to reduce the size of the implants and have a lift. Usually when implants are made smaller, a new internal pocket needs to be reconstructed for the new implants.

Exactly which surgery is right for you will be tricky to determine. There are concerns with the circulation of thinned skin, the risk of losing nipple sensitivity or the nipple altogether if the lift is too tight for the breast, or if the surgery disrupts blood supply.

Reformation of the pockets is a difficult operation with not totally predictable outcomes.

These issues are best handled by a plastic surgeon with considerable experience with revisional breast surgery. Usually complex revisional surgeries performed by accomplished surgeons are expensive.

For those patients contemplating very large implants, please consider the long term repercussions.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

You will likely need smaller implants and possibly a mastopexy

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Your situation will require careful surgical planning to give you the best results, but based on what you are saying you may very well need a lift as well as an implant exchange. This can be done and you can certainly achieve a very nice result, but make sure you see a Board-Certified Plastic Surgeon in your area with plenty of breast surgery experience in order to give yourself the best chance at a good result.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Depends on many different factors

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There are many issues here to address:

  1. Quantitiy of skin
  2. Quality of skin
  3. Volume of breast parenchyma
  4. Implant volume
  5. Implant surface (smooth versus textured)
  6. Implant position (under vs over)

It is extremely important to record several measurement of your breast and attempt to formulate a plan.

It may be that all you need is a downsizing and capsulorrhaphy.

Alternatively you may require a full mastopexy (breast lift).

Schedule a few consults and proceed with a qualified surgeon

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

There is no way to overcome gravity

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Large breast and breasts with large implants are subject to the effects of gravity just like everything else. At this point, you likely will require a breast lift in addition to an implant exchange. If you post pictures, we may be able to give you a better idea about your options. Good luck.

Very large breast implants can be uncomfortable

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It is unfortunate to hear that you were very happy for 12 years with your 330cc saline implants and somehow ended up with a 540cc implant when they were replaced. Some patients desire the fullness, and some require a very large implant to reach their goals, however the larger the implant relative to the breast tissue to cover and support the implant, troubles can occur. The implants can become heavy and ptotic (drooping) and the tissues can thin causing the implant to become visible and appear unnatural. I have noticed on this site a trend to larger implants. This may be a current fashion, but our goal is attractive beautiful results to last many years, perhaps a lifetime. We are not talking about hemlines.

There is a solution to the situation you are now experiencing. Your implants can be replace, and the pocket around can be reduced and shaped to improve the appearance of the breast. Breast lift techniques are also able to shape the breast and adjust the nipple size and position if needed. You do not need a superstar plastic surgeon, just one who cares (and is certified by the American Board of Plastic Surgery). Also note there is little difference in the weight of a saline and silicone implant of the same size.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Yours is not an easy situation

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I operated on a patient like you just yesterday having had her first implants in CA. I have done an extensive amount of breast surgery for 20+ years and I can assure you that this was not easy and required many of my best tricks. As the others have said, without seeing you, it isn't possible to say what you need. Certainly smaller implants are a must. Possible pocket revisions plus possibly a lift are also options depending on how stretched out your skin is. Go to the very best surgeon in your region. If you are in Georgia, I would suggest Dr. Rod Hester in Atlanta who is a master breast surgeon.

Going south down south

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Jen Jen,

It's unfortunate that you are now unhappy with your newer breast implants after only 2 years when it appears that you had 12 good years with the old ones. As you have discovered, saline is heavier than silicone and you have alot more volume of it at 540cc, than you had at 330cc. Large implants in general do not age well. It is likely that your tissues have now been stretched out by the larger implants and that you will need some sort of lift if you downsize the implants. See a board certified plastic surgeon to give you an idea what type of lift you would be eligible for. You might incur some additional scarring, but it might be worth the improvement in your breast shape. Good luck!

A not so unusual problem

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To answer your question, your surgeon will need to know your motivation and ultimate desires. If these are out of line with reality and good medical practice, then he/she can discuss this with you to arrive at a decision for what you need. A 32C size, that you were for 12 years, sounds very reasonable. At that size you should look quite good and fit most clothes well. Also, a 320 cc implant in someone your size is quite large. To know what to advise you now, one would have to know why you decided to go so much larger, and what your breasts look like now. Frequently, with an implant as large as the one you now have, there is enough pressure on the tissue that the breast tissue atrophies (virtually disappears). Because the skin and breast tissue is so thin, any reconstruction is exceedingly difficult, and almost always, when going significantly smaller, will require a mastopexy (lift). Although I almost never separate implant placement and mastopexy, this may be one of the times when it is advisable.

In summary, you need to carefully examine your motivations, desires and goals and carefully communicate them to a Plastic Surgeon who will take the time to thoroughly examine you and talk to you extensively about your desires. This is the only way you can arrive at a truly acceptable solution.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

My (not so?) humble opinion.

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Given a 32C bra size, the 475 cc implant even without overfill seems to be too large (especially in the diameter) for your small frame.

It is impossible to tell what exactly you will need to correct the situation. Without benefit of exam, I would recommend that you have the implants replaced with a smaller size, and see how things settle. You may or may not need a lift with this, but I would like to try to minimize risk/scar/cost, etc. Less is more. Examination is needed to tell for sure however.

I think that the other surgeons also raise good points to consider.


Too many variables to determine without examination

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Your situation is quite complex and will undoubtedly require careful analysis and long interactive discussions with your surgeon. You should remember that breast implant surgery is an imperfect operation and it is nearly impossible to get everything you want without some compromise, side effect, or complication over the long-term. It seems you will need to focus on priorities on what are most important for your to have (i.e. size, width, shape, texture, safety, etc.) and what things you can or cannot tolerate (i.e. rippling, roundness, amount of cleavage, risk of soft tissue thinning, etc.) It may take a number of consultation sessions to come up with a best fit procedure and define exactly what you mean by "perky", or you may find yourself needing to accept things you ordinarily wouldn't accept such as additional scars or a smaller size. Also, as you have experienced,there is more to breast implants than mere volume or cup size.

Also, things are made more difficult by the numerous and various surgeries and implants you have had such that a surgeon may have a difficult time to decide what is your normal size and shape. The ideal would be to remove the implants and start the analysis from scratch but usually this is not practical so there is an elemental of "guesstimation" and you must be aware of this "margin of error."

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.