Is it necessary to tighten pockets when downsizing implants with a lift? (Photo)

I am downsizing from 400cc moderate siltex mentor to somewhere between 215cc -235cc moderate smooth implants along with a lift. One PS I consulted with said he would have to tighten up the outer edges of my pockets a little. Another PS said he would NOT need to tighten because he was also going to be performing a lift at the same time; he also thought since I have mild capsular contracture it would be best to leave the pockets larger. What's your opinion? Thank you in advance for thoughts.

Doctor Answers 8

Tighten pockets or not?

It depends on the physical exam and intra-op findings.  If there is obvious pocket expansion, or mismatch between the old pocket and the new implant, then pocket plication sutures, or a heat-shrink technique for milder cases, may be necessary.  But it isn't always so.   Best to select an experienced, skillful PS who can do whichever technique is the best for you.

Orlando Plastic Surgeon
4.9 out of 5 stars 80 reviews

Breast Revision Including a Lift and Smaller Implants

It is definitely possible to #downsize to smaller implants and also alter the positioning; if possible. However, decreasing is size may also require a Breast #Lift to to #tighten loose skin, better optimize the end result. Any #revision has risks of unhappy outcome or other complications. #BreastAugmentation without a #BreastLift is usually a mistake looked back on by many patients. Most breasts will look larger and more droopy.They will sag more and sooner because of the excess weight altering the longevity of the results. The shape will usually not be satisfactory and sometimes results with “Snoopy” breast or double bubble. .A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is the most suitable for #breasts which sag or droop (ptosis) as a result of development, aging, pregnancy, breast-feeding and weight loss . Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy.
With both implant types there are choices when it comes to size, shape, and profile. The criteria best to suit you will be discussed in full detail at your breast augmentation consultation. Also, the right implant for the revision is contingent on shape of body and your desired outcome.
Altogether, the surgery will create an elevated, more youthful breast contour. Also, the nipple and areolae of the desired size and correct heightmay also be addressed. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Is it necessary to tighten pockets when downsizing implants with a lift?

Every Plastic Surgeon has their own experience to draw upon. Removal and downsizing with a mastopexy may be all that is required in this instance. The final decision is best made during the operation, whereby the relationship between the old pocket and the new implant can be assessed.

Thomas Trevisani, Sr., MD
Orlando Plastic Surgeon
4.9 out of 5 stars 64 reviews

Breast lift

Thank you for your question and picture.  I usually tighten the pocket when necessary based on the diameter of the new implant vs. the diameter of the old implant and the size of the capsule.  This is done to prevent the implant from falling off to the side. Pick the PS your trust to to your surgery and let him do what he feels in indicated.  However, be careful if the PS says he never tightens the pocket because I believe all options should be available during surgery to assure the best results.

Ramiro Morales, Jr., MD
Pembroke Pines Plastic Surgeon
4.6 out of 5 stars 28 reviews

Implant exchange

It may be possible to exchange the implants without a lift.  Your nipples do not appear to be too low and this would save you the scars involved with a lift.  An internal capsulorrhaphy would tighten the pocket laterally so the implants do not shift to the side.  Best wishes, Dr. T. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews

Is it necessary to tighten pockets when downsizing implants with a lift?

That decision is made at the time of surgery. Not before. Best to have signed consent for pocket revision just to be safe.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Is it necessary to tighten pockets when downsizing implants with a lift?

 Thank you for the question and pictures. Yes, sometimes adjustment of the breast implant pockets (capsule adjustments) may be necessary to achieve the outcome you are looking for.   Whether or not the adjustment of the breast implant capsules will be necessary will mainly be dependent on your physical examination; specifically, factors such as the amount of redundant skin and quality of skin elasticity will be important.   In my practice,  I generally DO use the capsule tissue (capsulorraphy)  to help keep the smaller implants in good position after this type of revisionary breast surgery.

Generally speaking, the best online advice I can give to ladies who are considering revisionary (downsizing) breast augmentation surgery is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "down a cup size” or "B or C cup" etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. 

3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals. I hope this, and the attached link (dedicated to revisionary breast surgery, specifically downsizing breast augmentation surgery concerns), helps. Best wishes.  

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


It sounds like the second plastic surgeon is just using the skin envelope to tighten the space around the implant.  The breast lift procedure involves skin removal and will hopefully tighten the space around the implant for the long-term. I personally don't think that is as reliable though as doing both.  Much of the decision is probably best made in the operating room.  Sometimes creating a new pocket is beneficial for holding the implant in a tighter position.

Edward S. Gronka, MD
Fayetteville Plastic Surgeon
4.7 out of 5 stars 13 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.