Want to downsize implant, can I go from high profile to low profile? (Photos)

Question

Started C cup. 2020 Had breast aug w/lift Silicone Mentor moderate plus 300cc L, 325cc R above muscle. DD cup now. Complication on R w/more bleeding/swelling & have capsular contraction on right. Never liked projection or size. Contemplating explant w/lift vs implant exchange w/lift. Curious if natural breast tissue is now compressed from implants? If I replace implants, would like lowest profile & much smaller, possible? Chest diameter: 31" Breast diameter: 9", waist: 29", hips: 37. 5'11" 150lb

Emre Guvercin, MD, FEBOPRAS · Answer

You can have low profile implants with similar or 1 cm size with plasma tightening of the implant pocket and skin to avoid a breast lift.

Chet Mays, MD · Answer

Thank you for your inquiry!  It is hard to determine how much breast tissue you have with the implant. But we would love to meet with you to discuss your concerns and help get you the breast you want.  Schedule a consultation with a Board-Certified Plastic to discuss your goals.

Daniel Barrett, MD · Answer

Dear KMAMK,

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

Gianfranco Frojo, MD · Answer

I would recommend total complete capsulectomies, new implants wrapped in Galaflex (slightly downsizing), and adding a lift. This is a complex surgery that needs to be approached by a very experienced revisionary breast expert.

Gregory Lakin, MD · Answer

Thank you for your question. Prolonged use of implants can compress natural breast tissue. However, some elasticity and volume may recover over time, especially after the removal of implants or replacement with smaller ones. You can safely downsize to low or moderate-profile implants and consider a breast lift to reshape your breasts after downsizing, mainly if there is skin laxity or nipple ptosis resulting from the previous augmentation. It is important to address the capsular contracture on your right side during the revision surgery. I recommend consulting a surgeon to evaluate your anatomy and goals so they can create a personalized plan tailored to your desired goals.

Warren Schutte, MD · Answer

Hello, you do have a lot of options moving forward. Please know that it is highly likely that you will redevelop capsular contracture if you get an implant exchange; however, it is possible to exchange to a smaller, more low profile implant. You could always move slow - get your implants removed, get a mastopexy/lift if it is needed. You can always decide in the future to place another set of implants. 
In my opinion, it is too much work to do at once to remove implants (and possibly scar tissue), perform a lift and replace implants in one surgical setting. 
Good luck with your breast journey.

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question. Downsizing an implant is possible but may require reduction in the size of the implant pocket with a capsule repair (capsulorraphy). A lower profile implant may obviate the need for this because low profile implants have a wider base width for a given volume than more highly projected implants. In addition, a reduction of the skin envelope with a mastopexy is often required to address any implant related skin stretch. Because of your history of capsular contracture you may want to consider Motiva implants, possibly placed below the muscle. Most importantly, you should consult with a surgeon certified by the American Board of Plastic Surgery who has extensive experience with revision breast surgery. I hope this helps. Good luck.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. If you wish to choose the simplest solution, it would be removal of the implants and a small amount of skin tightening.  This would remove what you stated you did not like which was the projection and the size.  From your photos it does not appear that you need a lift. However, when the volume of the implants is removed, you may wish to have a slight amount of skin tightening without elevating the nipple anymore, just to plump the remaining envelope of skin and give you as much fullness as possible.  Unless you have gained weight since the time of your first operation, your cup size should be approximately what it was before your first surgery.  With no implants, you markedly reduce the possibility of any future surgery.  If you choose to have a replacement of your current implants with slightly smaller implants of a different projection and some skin tightening, you must take into account the fact that you have a right capsular contracture and the possibility of you getting another capsular contracture around your new implant is elevated. Because of your capsular contracture, you would require a site change for the new implants from above the muscle to below the muscle to protect the implant.  Have a detailed discussion with your plastic surgeon about your options and the ramifications of those options. Best wishes.

Gary M. Horndeski, MD · Answer

Capsular contracture is more common with implants in front of the muscle. I recommend small implants behind the muscle. At size 32 or 34, each 100 cc of implant corresponds to 1 cup size change. At size 36 or 38, each 200 cc of implant corresponds to 1 cup size change. From this, you can determine the size required to achieve your desired goal. You would also benefit from a circumareola lift at the same time to take in the skin envelope.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Brendan Alleyne, MD, FACS · Answer

Complex situation but one I do see routinely in my revision and reconstruction breast augmentation practice. Given your NAC position likely you would not need a lift even if downsizing pretty significantly. A more natural appearance could be had by doing a combination approach. Downsizing the implant and going to a lower profile in a submuscular dual plane. So doing a plane conversion. Then capsulorrhaphies to redefine the pocket. 
Likely 3 weeks in a breast bra splint and then wearing compression bra 6 more weeks at night. 6 weeks of limited lifting weight.

Want to downsize implant, can I go from high profile to low profile? (Photos)

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