Downsizing implants- do you have to make pockets smaller?

Question

If I wanted to downsize implants, (allergen mod, sili, 457l, 492r)- how could I safely do so? Do you make pockets smaller? I have heard that if you go smaller that it could be like "putting a foot into too wide of a shoe"- is there a limit (cc) to which you can downsize comfortably? I am only worried about pocket not lift issues- what do I need to know if downsizing??

Brian C. Reuben, MD · Answer

Thank you for your question.  You already have a good grasp on what the issues are with downsizing of an implant.  There are many factors that go into what may need to be done at the time of surgery.  If you downsize significantly, then the implant base will be narrower and the pocket wider and the implant may shift around if nothing else is done.  However, best not to worry about this at this point.  You should decide an implant size based on your aesthetic desires and then meet with a surgeon who can then explain what needs to be done.  Best of luck.

Vincent N. Zubowicz, MD · Answer

there are number of variables that go into deciding whether or not there will be a pocket adjustment at the time of implant exchange larger to smaller. In the presence of capsular contracture, most surgeons would do a capsule ectomy.

John J. Edney, MD · Answer

Whether or not you will need some downsizing of your pocket depends on the current pocket size and the amount of downsizing that will occur.  You should plan on the possibility of downsizing the pocket at the same time as your implant replacement.  Your surgeon will probably have an opinion preoperatively but very often the final decision is made in the operating room.  Good luck

Steven Wallach, MD · Answer

When downsizing there are several variables that might need to be addressed. One is the pocket size, the other is the soft tissue in terms of potentially needing to be lifted as well.  Best to be seen in person.

Tom J. Pousti, MD · Answer

Thank you for the question. Overall, I think that you have a good understanding. Generally speaking, whether or not a patient's breast implant “pocket” needs to be adjusted at the time of downsizing of breast implants will depend on the size of the new breast implants versus the dimensions of the breast implant capsule space. Also, if a patient has a breast implant displacement problem, adjustment of the  breast implant capsule may improve her outcome. My best recommendation: select your plastic surgeon carefully. Make sure that he/she is a well experienced board certified plastic surgeon who can demonstrate significant experience with revisionary breast surgery. Then, it will be important to communicate your goals carefully. You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you as you learn more. Best wishes.

Melek Kayser, MD (retired) · Answer

Thank you for your question. There are many variables that go into the decision making process when a patient desires to reduce her implants size. This would include the amount of reduction in implant volume, the degree to which the pocket was expanded, the quality of scar tissue surrounding the implant, the degree of the position of the breast on the chest wall, and of course, the quality of skin. In some cases, a reduction of the capsule can be performed with simply closing part of the excess tissue with stitches. Another option which is relatively new, is too exchange your implants with fat. This is a more detailed approach, however, but once the implant has been replaced with fat, the concerns of implant issues are no longer present in the long run. Fat is natural, all yours and has the potential to last a lifetime. I hope this helps and have a wonderful day! Dr Kayser - Detroit

Downsizing implants- do you have to make pockets smaller?

Answers (6)

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