How much smaller can I go, is 240/270 cc ok? I have 320 cc UHP that are too large for my frame and asymmetrical. (photos)

Thank you for your question and for attaching photos. To really notice a size difference you are going to have to use an implant that is at least 100cc smaller in my opinion. Even that is going to be a small difference. Something in the 200cc range in a full/mod plus profile should take you down to where you are looking to ultimately be, but there are some risks with it just like any procedure. You may have excess skin from going smaller and the current capsule is larger than the new implant. Each time a revision is performed the capsular contracture rate increases. I always say "the enemy of good is better", meaning you have a good result now. You and your surgeon will have to determine what is best for you and your body. Best of luck.

Yes, I would downsize down to around 250 and change the profile to moderate plus or high profile (from Ultra High), to give you a more natural look.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
With regards to your specific question,staying within the parameters as defined by your BWD you should yield a reasonable result (+/- 1 cm). Typically exceeding BWD is worse than the alternative. I would also caution that a 50 cc size differential is subtle (approximately equivalent to a shot glass). It is unlikely to make a significant difference. If you are seeking a more appreciable change you may choose to go smaller. However, this is best determined via in-person exam. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Hello,You can go as small as you want. What I presume is unacceptable is the degree of projection of your breasts, attributed to the UHP of the implant. Choosing moderate or low profile implants with a similar diameter will work well. This is not a simple operation, and should be done by a revision breast specialist who is accustomed to downsizing implant pockets for the newer, smaller implants. Best of luck!

Dear littleperson1,breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

with a surgeon to discuss your concerns (I do not appreciate asymmetry from your photos at a distance) and what you are expecting by downsizing.  The biggest challenge with downsizing is it has to be some arbitrary decision and it may still not meet what your expectations were.  If you hadn't expressed any dissatisfaction, I would have thought you would be a happy patient as the size does not overwhelm your frame but breasts are a very personal decision and yours is the most important.

I am sorry to hear about your concerns after breast augmentation surgery.   Keep in mind as you are thinking about your goals that sometimes adjustment of the breast implant pockets (capsule adjustments AKA capsulorraphy) may be necessary to achieve the outcome you are looking for.   
Generally speaking, the best online advice I can give to ladies who are considering revisionary (downsizing) breast augmentation surgery is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "down a cup size” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. 
3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals. Essentially, the procedure will come down to downsizing enough to achieve your goals while NOT downsizing too much where "sagging" skin becomes an issue.  In this regard, the use of temporary intraoperative sizers utilized once the breast implant capsule adjustments have been made, are very helpful.
 
I hope this helps. Best wishes. 

Dear Littleperson1,Hello and thank you for your excellent question. You may want to look into a breast implant revision and simultaneous fat transfer procedure that combines both liposuction with laser, radiofrequency (RF), or acoustic therapy to produce the best balance of fat reduction, skin tightening and smoothing at the liposuction site, and maximizes your fat graft success at the transfer site (i.e., breast, buttock, hand, face, or elsewhere). For the last 12 years, we have been developing a proprietary technique that we call IDEAL Liposuction. First off, all devices and instruments used are FDA-approved, unlike some of the liposuction and fat transfer devices being used today. We only use techniques that have been proven to minimize the risk of complications of fat transfer, like fat embolism, but following all recognized guidelines. We typically use Smart / Laser Liposuction or VASER (ultrasound) to reduce dense, fibrous fat, stimulate collagen formation, and obtain the best fat graft possible; Radiofrequency-based skin tightening (like Body Tite, or Thermi) to maximize skin contraction; and Ultrasound, RF, or subcision (Z Wave, Venus, Cellfina) to treat cellulite, increase blood supply to the fat graft site, and get rid of any lumpiness that can occur after fat grafting. Patients go home the same day as surgery, do not need any narcotics postop for pain control, and can return to light exercise and work two days after their procedure. In my practice, we select the appropriate treatment for each patient based on their skin quality, amount of fat and surgical goals. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 - 2018

Thank you for your question, the difference between 320 UHP and 270/240 is not substantial and you would likely not notice much of a difference. It would be advised to speak with your surgeon and see if you could drop down in projection (Mod Plus Xtra or High profile Xtra) There are 2 new projection types from Mentor that may be better suited for your frame there is 200cc HP Xtra which measures 9.2cm in diameter and 235 cc HP Xtra that meausres 9.5cm Ultimately the choice is yours just ensure to be very clear with you PS what your expectations are.All the best