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

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.

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.

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.

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.

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.