Need an Expert on Implant Exchange Larger to Smaller? (photo)

Presently have 550 cc high profile after revision 15 months ago from 350 cc. Had capsulectomy both implants pocket switch from over to under muscle and doughnut mastopexy. Body can't handle 550cc want to exchange to 350cc. My surgeon tells me reshaping pocket and revising lift to go down that much he guarantees complication with either shape, CC, scars. He said he does not feel comfortable going down so much it makes revision extremely difficult. Who has expertise in this type of surgery?

Doctor Answers 7

Need an Expert on Implant Exchange Larger to Smaller?

I do not see a significant problem downsizing. I would suggest going smaller. However I would not suggest going all the way down to 350 mL.  I would see if possible 400 or 425 mL would be acceptable. Yes, the complication rate is slightly higher, but I do not think it prohibits Surgery from being performed. Internal sutures of the capsule will have to be done to create a smaller pocket.   I would suggest staying above the muscle.  I believe that your mastopexy or breast reduction can still be performed through your doughnut mastopexy incision. Good luck. Sincerely, Dr. Katzen

Los Angeles Plastic Surgeon
5.0 out of 5 stars 207 reviews

Downsizing implants

Hi, like others said, revision breast surgery in general is sometimes more difficult and has a higher complication rate, but I dont see a big problem with downsizing. first you need to be examined to assess the skin envelope condition and flexibility, etc and then you can decrease the size of the implants along with decreasing the pocket size surgically, or if possible you can go for a lesser decrease in size (maybe to 450?), without need for internal suturing. your board certified surgeon will be able to tell you what option is more optimal for you and him to perform.

Antoine A. Hallak, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 5 reviews

Implant exchange to 350 cc

There is no doubt that revision surgery is more complex and more demanding. It also carries its own risks, including asymmetry and internal suture failure. But, It can be done and in your situation, from the photos you provided, I think you will need internal suturing and possible revision of the mastopexy to remove the excess skin. 

All this is no replacement to office consultation and examining the breast. I wish you all the best.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Downsizing implants

Downsizing implants can be a bit tricky.  It may require a lift and capsule work internally.  An exam would be essential.

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

Exchange Larger to Smaller

While fairly straightforward, the surgery will require an experienced and expert board certified plastic surgeon. The quality of your skin elasticity will be a limiting factor, and the surgeon will need to repair the pocket.  If your surgeon has voiced concern, do not push him/her. Instead, consult with 3 - 4 board certified plastic surgeons to explore your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 42 reviews

Expert on implant exchange larger to smaller

The procedure that you are considering is fairly straightforward, but not a simple one.  Different plastic surgeons have varying comfort levels with certain complicated procedures based on their experience, training, past results and your anatomy.  I would definately not proceed with a surgeon who tells you he doesn't feel comfortable with a procedure that you want and discuss your goals with other board certified plastic surgeons.  Ask to see results of your planned procedure that he/she has done before making a decision.

Leonard T. Yu, MD
Maui Plastic Surgeon
4.3 out of 5 stars 27 reviews

Revisionary Breast Surgery to Decrease Breast Size?

Thank you for the question and pictures.

How much your breast  implants can be decreased in size will depend on factors such overlying skin elasticity. The quality of skin elasticity will depend on factors such as the presence of stretch marks, previous pregnancy and/or weight gain/loss.

It is likely that, in order to significantly decrease breast implant size, that internal suture techniques (capsulorraphy) will be necessary to decrease the breast implant pocket size as well. Otherwise, the breast implant pockets will be too large for the breast implants and you may experience significant breast implant movement/displacement issues after downsizing of breast implants (“rock in a sock phenomenon”).

I would suggest that you meet with well experienced board-certified plastic surgeons who can demonstrate significant experience with revisionary breast surgery.

Communicate your goals clearly (I prefer the use of “goal pictures”).

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 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.