Revision surgery. How much smaller can I go with an implant exchange? 375cc to 250cc? Current Gel/ mod profile/sub musc (Photo)

Surgery in 3 wks. My surgeon thinks I can go no smaller than 275cc and stay mod profile for best outcome. I am 5'10, 120 pounds. Shoulders 16" across and Rib cage 30". How small can I go, without revising the current pocket? Can I go to a low profile for a flatter (desired) look? What I dislike the most about my current breasts is how far out they protrude and the fake looking upper pole/ too big for my body. I am hoping for a smaller breast B cup (I know this is subjective) and natural slope.

Doctor Answers 13

How Much Smaller for Revision?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The greater the amount of reduction in implant size the more likely you will need a pocket revision. This is not only based on the implant volume but also the base dimensions of the implant. Based on that consideration, you could downsize the volume and go to a lower profile implant which may have a similar or only slightly smaller base dimension than you have now.

Your concerns are also not just a matter of the implant size but also the implant position. Your implants are positioned somewhat high giving you dramatic upper pole fullness along with a somewhat underfilled lower pole.  If your goal is to achieve as "natural" a look as possible, then you should seriously consider getting an anatomic or tear drop shaped implant. This type of implant is specifically designed to provide a more natural slope off the chest wall without the obviously "augmented" appearance that can occur with round implants, particularly in patients with thin tissues in their upper breast/chest. This is the type of implant that I frequently recommend in patients with thinner tissues whose goal is to have a more "natural" appearance following augmentation.

Revision surgery. How much smaller can I go with an implant exchange (375-250)?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
From the looks of your photo, I believe the absolute smallest you could go would be 250-275. You must realize that when downsizing you run the risk of having extra skin and, therefore, potential rippling and sagging. If you are determined to go smaller than 250 then it is advisable to get a skin tightening procedure such as a breast lift at the same time. You can definitely have a lower profile implant which would cause less projection and eliminate the fake-looking upper pole that you do not like. In the process of doing your breast surgery, I am sure your surgeon will perform a capsulectomy which is removal of the old scar tissue. Removing this capsule will also help the upper pole to relax and form a more natural slope.

Going smaller in implant size

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
can certainly be done but as you go smaller, the implant width also gets smaller and this could eventually result with your lower pole having all of the implant with your nipples pointing upwards and a concave, ski-slope upper pole (which is what you do want).  Pick a size you like and consider using a vertical incision to allow some tightening of the envelope once the new implant is in.  You should be able to choose whatever implant you want... you're the patient.  In my practice, I utilized this vertical plication to help minimize the chances that the bottom will be too heavy and my patients have been very happy.

What size to look smaller

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
A low profile  round implant or MM410 in my opinion would give you the most natural look. I agree with your plastic surgeon that downsizing at least 100 cc would be necessary for you to feel like you are definitely smaller. Sounds to me like you and your plastic surgeon have come up with a very good plan.  Best of luck. 

Downsizing breast implants that are too large.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thanks for your question and photos.  It appears that the implants selected were too large for the skin and breast tissue that you had at the time of surgery and never settled or stretched adequately.  I agree that the best time to decide on your final implant size is during the surgical procedure when the shrinkage (if any) of your capsule will be evident and test implants or sizers can be placed.  I would personally stick with a mid profile implant and aim to use implants between 275-325 cc with the option of conservative lateral capsulorrhaphies to close off the outer pocket and maintain your cleavage.  Cleavage will suffer with too small an implant but a reduction of 50-75 ccs should primarily reduce the excess upper breast pole fullness.  
Allow your surgeon to do his/her best for you and to choose the best implant during the procedure.  Regards.....

Jon A Perlman MD FACS
Certified, American Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Breast Im

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I appreciate your question.

The size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the top (upper pole fullness).
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute

How much smaller can I go with an implant exchange?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
This is not a question we can give a specific answer to without an exam. The best way to get the look you want is to show your surgeon wish photos and during surgery have him/her try different volumes of implants by using sizers during surgery to determine what volume works best for that goal. 

Revision surgery. How much smaller can I go with an implant exchange?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for the question. Based on your question, I think you may already have a very good understanding of what might be involved with downsizing of breast implants. As you mentioned, adjustment of the breast implant pockets (capsulorrhaphy) will likely 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. I think that this will be the most important decision you make. 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” or "B cup" 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.
I hope this, and the attached link (dedicated to downsizing breast implants surgery concerns), helps. Best wishes.

Revision surgery. How much smaller can I go with an implant exchange? 375cc to 250cc?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question.  You may switch to a smaller low profile implant but it's hard to say whether you need a pocket revision until the new implants are in place.  It's probably likely.  

Smaller, lower profile

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
You could go to 250 and a lower profile.  It will not be absolutely sure the effect on the pocket util the surgeon has the new implants in place.

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.