I'm 5'7", 130lbs, lean athletic figure; chose 450cc HP implants 4 years ago; unhappy with size. Downsizing to 250cc?

I liked my my breasts before implants & wanted more. I was told "you have broad shoulders & can have larger implants, everyone wishes they went bigger." I chose 450cc HP over muscle & knew I went too big. I am 39, DD, never breastfed, good skin quality & have breast tissue for B cup. If I downsize, will surgery be successful after 4 yrs? Will skin shrink to smaller implant; can I switch to smaller implants in 1 surgery? Do I need new pocket or 2nd set of higher incision sites to change my fold?

Doctor Answers 9

Uhappy with breast implant size

HI Cocoum,

 Sorry to hear that you were not pleased with your  breast implant size. If you go down to 250cc's , you may need to have a tightening of the lower pocket so that you do not get a lot of wrinkling and rippling.
Changing the pocket will not make a huge difference because it is the lateral pocket width that determines how wide and big an implant needs to be and that will not change , even if you have new implants placed beneath the muscle.
  With a  tightening of the pocket, you may need to have a lift or just a vertical incision to bring the loose skin in medially.
It would be best to discuss this issue with either your previous plastic surgeon and/or seek consultations from other board certified plastic surgeons in your area.s in your area.
Best Wishes,
Dr. Christine Rodgers

Denver Plastic Surgeon
4.9 out of 5 stars 90 reviews

I'm 5'7", 130lbs, lean athletic figure; chose 450cc HP implants 4 years ago; unhappy with size. Downsizing to 250cc?

Thank you for your question.
I am sorry to hear that you are not happy with the breast augmentation procedure. Generally speaking what breasts look like after downsizing depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back) and the size of the implants used. Based on your photographs, I think that you should do well with downsizing of breast implants and capsulorraphy. Breast lifting will likely not be necessary.
An in person evaluation is the best way to receive the most accurate advice as to how to proceed with your breast implant downsizing surgery.
Once you are certain that you wish to proceed with reduction of the breast implant size, I suggest finding a well experienced, board certified plastic surgeon who can show you examples of his/her work.
I hope this, and the attached link (dedicated to breast implant downsizing surgery concerns), helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Revision Breast Augmentation


It is impossible to answer your questions without even the benefit of photographs, but that's OK because a physical examination is warranted. I suggest consulting with other surgeons as I'm not in agreement with the philosophy of your original surgeon. Your next surgeon should be expert in revision surgery, as this is much more complex than a primary breast augmentation.  Additionally, certification with the ABPS and membership with the ASAPS are important too.

In general, my recommendation would be removing the old implants with the surrounding scar capsule and replacing smaller implants under the pectoralis muscle.  Based on your anatomy, a breast lift may be required, but examination will determine this.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Downsizing Breast Implants

You questions are valid, but very difficult to answer without an exam.  Skin quality is very important here and that is what will determine if anything else needs to be done other than a simple swap.

Often the pocket needs some internal adjustment so the smaller implant doesnt fall off to the side.  At times patients need a lift to obtain a better result.  It just really depends.  I have done implant exchanges from 650 cc to 300 cc with nothing more than pocket adjustments.  I generally recommend to patients that they need to decrease the size of the implant by at least 100 cc to see a noticeable change and about 180-200 cc would usually be about 1 cup size smaller.

It is best to be evaluated by a board certified plastic surgeon that has great deal of experience with breast revision surgery.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 77 reviews

Downsizing implants

The most common reason patients have another surgery after breast augmentation is because the size is not right and it is split equally between too big and too small. If you want to decrease the size of your breasts, you should consider a change of 100cc minimum to notice a difference and about 200cc to go down at least a cup size.

Breasts with good skin elasticity and implants that were placed under the muscle can often bounce back well without the need for a lift or different incisions after implants are removed or downsized. For breast with poor elasticity and stretched out tissue, a lift is sometimes needed to reduce the amount of skin to prevent the breast from being droopy over the implant, and this usually requires a new lollipop type incision.

Depending on the implant you choose, a new smaller pocket has to be created in the breast. You may need to switch them to under the muscle and you may need to use a tissue matrix or scaffold to help hold the implant in a smaller space. This is especially important for textured implants and the anatomically shaped teardrop implants to decrease the risk of both rotation (flipping of the implant) and malposition (implant getting stuck in a bad position).

Kamakshi Zeidler, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 18 reviews

Downsizing implants

Without seeing you, it's difficult to answer your question. In most cases, to take  down the volume of breast implants 200 mL, sutures can be placed on the inside to reef up the space occupied by the larger implants. On occasion a horizontal wedge of tissue may be needed to shorten the distance from the areola to the inframammary crease. Sometimes, however, a vertical mastopexy may be necessary if the skin envelope is very stretched and the nipple areolar complex is droopy. I recommend that you see a board-certified plastic surgeon in your area to examine you and cancel you good luck. 

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Downsizing Breast Implants

You point out some of the negatives of having had too large implants placed.  After four years even with good skin elasticity I'm concerned that your pocket will need reduction in size and you may need extra skin removed in the form of an uplift procedure.  450-250 ccs is too dramatic a change in implant size IMO to not deal with extra skin and/or pocket size.

Discuss options with your surgeon and if you're not sure that you're getting good advice seek the opinions of other ABPS Bd Certified doctors in your area.  Good luck with your decision.

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Downsizing implants

Downsizing is always a possibilility but we do not have nearly enough information in your case to give any reasonable answer. See an experienced surgeon for an exam and make sure you have all the info from your previous procedure for the doctor to review. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Revision breast augmentation involves countless factors

You have many questions and it would very difficult, if not impossible, to give good conclusions without personal examination.  Nevertheless, I will state the variables that you should always take into consideration.

*  Skin elasticity.  If you have a good skin quality, your breast can shrink with no or very minimal droop.  But since it is hard to predict this, it is not uncommon to wait for a couple of months after implant removal to see if one needs a corrective surgery to address the saggy appearance. 

*  Previous implant size.  The bigger the implants are, the more skin and soft tissue stretching they might cause.  This may contribute to the drooping appearance. 

*  New implant size.  If the surgery involves drastic downsizing, there is an increased risk of drooping appearance, which of course necessitates another procedure--e.g., pocket repair, breast lift, or combination of these two. 

For photo reference, you may want to visit the link below. 

I hope that helps and good luck.

Dr. Tarick Smaili
California Surgical Institute 

Tarick K. Smiley, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 116 reviews

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.