Advice on downsizing implants? (Photo)

Question

Background: 5’2, 140 pounds. Started with an A cup. First breast augmentation: 360cc UTM brought me to a large B/small C Second breast augmentation: increased to 560cc UTM a year later. I do not like the size. It looks unproportionate on my frame and uneven. I’ve attached a photo for reference. How soon after surgery can you downsize? Can I get away with just pocket adjustment maybe an internal bra vs a lift since I started small? Thank you

Wayne I. Yamahata, MD · Answer

Although ideal breast size is very subjective, I agree that smaller implants would be more aesthetically appropriate. It appears that you would benefit by having a wider separation between your breasts. If a pocket adjustment is planned, then I would favor waiting a least six months postoperatively before attempting this type of repair.

Daniel Barrett, MD · Answer

Dear user162626,
you can wait to see the final results. But if you are sure that you don't like the size, you can get exchange earlier. 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

Your breasts are low on the chest wall. You would benefit from implant exchange and donut mastopexy to take in the slack skin. Also, you need plication of the breasts medially and laterally. I suggest waiting 6 months from the last surgery before doing any revision.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Darryl J. Blinski, MD · Answer

Based on your posted photos, you can downsize approximately two months to three months after the recent surgery, but you did not text. What date was the upsizing surgery done? During that surgery most likely downsize to the three 6400 cc Modder profile plus range with pocket tightening by suture technique or internal mesh and then externally under the skin delays. $10,000-$18,000 depending if Ms. used again best virtual consult with.

Hilton Becker, MD · Answer

Your breasts do look too ,large for your frame.
Downsizing could be done with internal pocket tightening without a breast lift

Connie Hiers, MD, FACS · Answer

Yes, this size is too large and heavy for your frame. You should be able to go down to 400-425 cc's with probably just an internal lateral pocket tightening. You covered up your nipples, so I cannot say anything about needing a lift. However, go down to a size that you will enjoy for a long time. Somewhere between 300-350 cc's would be a very nice nice for you for several years.

Mats Hagstrom, MD (license on probation) · Answer

Anytime, excessively large implants are used the chance of undesirable side effects, complications and need for revision surgery will go up.
The bigger the implants, the more likely the patient is to have problems and need more surgery.
For patient in your situation would recommend downsizing ASAP.
If you do it during early healing stages, then the tissues respond really well before they’re stretched out, and the capsule takes shape around the bigger implant.
I would probably simply downsize without doing any closing of the pocket and see what happens.
The tissues will shrink and eventually catch up to the smaller implant.
It will look a little odd at first, but your breast shape is good and it looks like you have really good pliable tissue.
 it’s better to not manipulate too much if we can avoid it.
This includes permanent sutures and mesh, which is better to not use unless it’s needed.
I would go low profile wide diameter smaller volume. 
Each plastic surgeon has their own way of guiding patients through the implant selection process.
I’m an avid believer of not violating the natural breast diameter.
Doing so set patients up for long-term problems. 
To me, I think you’re in great shape for downsizing without making it complicated.
Recognize that there is an adjustment For the soft tissues to catch up.
I’m not sure when your surgery was, but as I mentioned, there is a window where it’s ideal to downsize after that, it doesn’t matter so much.
If you’re not having other problems like bottom out or capsular contraction then I think you’re gonna do great with downsizing.
I would definitely avoid any external surgery in conjunction with downsizing unless it’s needed later.
How are you going to choose the correct size implant for you?
How was your current size determined?
Did you decide the implant size or did your surgeon decide? 
All things being equal provider selection is the most important variable.
In your case for no other reason and then guiding you through more appropriate implant selection.
A lot of patients really push for big implants and they’re not going to have it unless the surgeon goes along with it.
If the surgeon doesn’t give them the big implant still just go to another provider who will.
These are the same patients who then have implants that bottom out with multiple Revisions and possible long-term implant failure.
Dr. provider about downsizing and try to figure out what the right size is for you.
Personally, I think in your case wide diameter low profile is the way to go in regards to shape.
This will allow To fill the pocket even though go down.
Each surgeon will have their own view on this.
Of all the patients who have issues after breast augmentation, I think you’re in good shape for downsizing.
Counter blessings that your surgeon did a nice job for you other than the implant size and you’re not dealing with other complications.
Good luck,
Mats Hagstrom MD.

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