Best Way to Downsize After 16 Years? (photo)

Hi, I'm 46-years old. Saline implants 16 years ago. 275 filled to 325. I'm 5'1" and 102 lbs. Areolas too large (stitch came out of one several times, left it alone most recently) after donut lift. Want to downsize to a full A or small B, in addition to lift & areola adjustment. What is the best way to do this? One surgery? 2? Deflate first? Remove enormous capsule? Is it inadvisable to reduce the size of the capsule, so a low profile implant would be recommended? I wear a 32D. Thanks.

Doctor Answers 12

Downsizing implants, skin management, and the final look.

Downsizing implants is a common operation. Most times, some degree of skin management (mastopexy) is required. To go from a D cup down to a full A or small B is likely going to require either a vertical mastopexy (lollipop), or an anchor scar. Both of these approaches to the reducing the skin can improve the size of the areola and because the tension of the mastopexy is not soley on the areola, distortion afterwards is usually minimal. In other words, the areola is not likely to spread like it did after your previous "donut" mastopexy. As for the capsule, if there is no contracture deformity, I prefer to remove the excessive capsule outside the boundaries of the new implant and using suture techniques to close off the space. A postoperative bra for 4-6 weeks night and day helps to stabilize the breasts while the new areas heal in the proper position. To go to a full A or B, you may not require any implant at all in which case a full capsulectomy is recommended to prevent a long-term fluid collection in the old implant space.

Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Best Way to Downsize Breast Implants After 16 Years?

Thank you for the question and pictures. As you have noted in your question, there are many different ways to handle your situation. Much will depend on the specific plastic surgeon's experience and judgment along with your preferences.

 The most important decision you make would be selection of your plastic surgeon. Make sure that he/she is a well experienced board-certified plastic surgeon who can demonstrate significant experience with revisionary breast surgery. This decision, as opposed to decisions such as an office deflation or not, will be the most important one you make when it comes to successful outcome with your breast surgery.

 Once you have chosen your plastic surgeon carefully, communicate your goals carefully as well. In my practice, I find the use of goal pictures very helpful during this communication process. Breast lifting will certainly be necessary; make sure you understand the potential downsides associate with breast lifting surgery as well. Achieving realistic expectations prior to surgery will also be important.

I hope this, and the attached link, helps.

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

Your best bet will depend on the details of your goals...

Hi there-

Whether I would recommend simple in-office deflation first, or removal of your implants with or without replacement and with or without a lift would depend a great deal on your goals for appearance and the experience you are hoping to have...

If you are not put off by the inconvenience of living with deflated implants (and the potentially not beautiful appearance of the sagging skin) for a while as you wait for the skin to adjust, this option may allow you a "sneak peek" into the future by helping you understand how you might look if you simply removed them. This would therefore make it easier for you to decide if you want to have smaller implants placed, with or without a lift.

On the other hand, if living with deflated implants and breasts for a few months seems like it might bother you, and you are fairly confident in your goals for appearance already, then I would forego this somewhat inconvenient process and proceed with the procedure most likely to achieve whatever that goal is. Without examining you to better understand the volume of breast tissue available, it is difficult for me to make a recommendation.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Breast lift and implant removal

Sometimes it is easier to deflate or remove the implants before undergoing a lift. Sometimes patients do not have alot of tissue and with implant removal there may not be alot to lift. Best to be seen in person.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Consider pre-op deflation

With saline implants, when women are considering down-sizing, I think it's very helpful to use pre-operative implant deflation.  You'll get a chance to see what your size would be without any implant, or try on a new implant that's smaller, just like a first time patient.  Also, it will help with planning of any breast lift that you might need.  Based on your comments and photos, I would suspect that implant removal, no replacement, and a lift would be needed to give you a nice result, but of course, an in-personal consult and examination should be done. 

Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 79 reviews

Removing implants

Obviously, you need to consult with someone who can examine you in person, however, based on your picture, I would say just take the implants and capsules out and either leave them out or use a smaller volume implant.  Your breasts may look slightly deflated at first, but your body doesn't like empty space and the skin will tighten down fairly quickly.  It's kind of like doing liposuction on someone's thigh.  There you are removing volume as well.  The skin doesn't just spring back tighter.  It takes a few months for it to tighten down.  In fact, most doctors would put you in a compression garment for a while after liposuction surgery to help close that empty space.  I would suggest doing the same for your breasts.  You could remove the implants in conjunction with a donut lift revision as well if you wanted to.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Best Way to Downsize After 16 Years? (photo)

You need IN PERSON evaluations to determine a surgical plann. How hard or the capsules? What scar formation would you accept? etc. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Best way to down size implants

If you deflate the implants first and allow the breast tissue to shrink back for a few days to a week or so, you will be able to determine how droopy your breasts are and what type of lift you will need.  Also,muon will be able to try on sizes to get a sense of what size implant  if any you may want to put back in.

Todd C. Case, MD
Tucson Plastic Surgeon
4.9 out of 5 stars 55 reviews

Breast augmentation revision

From your photos you would seem to be a good candidate for a vertical type breast lift combined with a smaller implant if desired.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Best way to downsize current Breast Implants

I would recommend an in office deflation followed by a re-examination in 6 will most likely want/need some type of very small silicone implant combined with a true lift......but would recommend deflation as your first step..good luck.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 85 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.