Getting Smaller Implants - 700cc to 500cc Feasible?

Hi. Four years ago I made the stupid choice of getting 700cc (Round smooth silicone, high profile, 14.4 x 6.2cm)breast implants. I am a tall girl, 5' 81/2" and 135 lbs. I wear a 36 band bra. My current cup size is WAY to large! My breasts look extremely fake and i am very self-conscious. Before the 700cc implants I had 400 cc anatomical implants to correct tubular A cups that were also asymetrical. I felt the 400ccs were too small. The 400cc (12.5 cm x 13 cm x 4.9cm) implants were submuscular and looked very natural, they were just small on my broad frame and seemed to be 10 miles apart. I got the 700cc implants to get a cleavage. I hate the high profile, they look really fake and I wanted a natural look. I am getting a revision soon and the doctor recommended Mentor Moderate plus profile, size 450 or 500cc smooth round silicone implants. The dimension of the 450cc implants is 13.6 x 4.2, the 500cc is 14.1 x 4.3cm. I would like a small D, right now I wear a 36D but I know it's the wrong size because the bra cups fit on the breasts like a baseball cap. I just want breasts that look "real". He said he would have to do a lift (hopefully just around the areola). Do you think going from 700cc to 450 or 500cc is feasible? Can this still produce pretty breasts that look "real"? What is your experience with downsizing?

Doctor Answers 45

This sounds possible

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You have obviously spent a lot of time analyzing this. Please recall that you started out with tubular breasts, the hardest starting point for breast augmentation and one which will never allow the "perfect" result. Plus, multiple surgeries will also not ever be as good as one that went really well.

That being said, I would suggest you consider the Mentor moderate profile gel implant family of the same width as your current implant if you want to maintain the same proximity of the result to the midline. The moderate plus family also looks much more "real" than the high profile style but is still not truly natural. The key is to keep the same base diameter you have if you want to prevent your next set of implants from looking too far apart again. The lift will restore the proper position and elevation of the nipple and can tighten up loose skin depending on what kind of lift is done.

As always, don't get hung up on bra cup sizes, just worry about the "look" you want and the bra size takes care of itself.

Downsizing breast implants with natural result is possible

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Yes, I have taken care of many patients in your situation. It is possible to downsize and get natural looking results.

 It is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" 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.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

An implant SIZER used DURING surgery will show ideal implant size.

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To Ellie26,

Hi! You should definitely get smaller implants. Some specific suggestions:

1) Show your surgeon a picture of breasts that you think are perfect. Then he will know what to aim for.

2) A sizer is a temporary saline implant inserted into the breast pocket. You are then put into the sitting position (you are still under anesthesia, of course) and different volumes of saline are tried to see which is the largest volume that leaves you looking natural. Then the sizer is discarded, and the correct size Mentor Moderate Plus implants are used. This step takes all the guesswork out of the process!

3) As a preliminary guess, I would say 450 cc's would be about right. Looking natural means avoiding too much roundness on top. Remember, there is a built-in conflict between big and natural. So you have to help your surgeon know where to make the compromise. It is different for each woman. I recommend not going too big. Maybe the problem with your original 400 cc implants was not the size but how the pockets were made.

4) The pockets will be too big now for smaller implants. The pockets will probably need to be reduced with a capsulorrhaphy (suturing some of the pocket edges).

5) Your breasts are probably stretched out. Don't be afraid of a lift. You may well need a lollypop scar. This will probably be the secret to success. I can tell you, from long experience, that scars are much preferable to bad shape.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

You will be happy with smaller implants

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The downsizing the implants are done often when the patient or plastic surgeon decides to go bigger than the limitations of the soft tissue. the size of the next implant should be decided in consultation with you plastic surgeon. there are many issues to consider including your soft tissue,chest width, nipple position ,quality of your skin, breast fold position and your expectations. You may or may not ned lift and that will depend on the position of the nipple position. In my practice I try not to do the lift at the same time . Your tissue is stretched and when you go smaller it will shrink to some degree.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

May need a lift

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The problem of going smaller is the excess stretched skin that you had over few years. In general if your skin is elastic, most of this skin will recoil hopefuly with no problems. You might require a lift and the extent of the lift could only be accessed by your board certified plastic surgeon.Good luck

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Subfascial placement for a natural but full appearance

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To create a natural appearance, nothing compares to the cold-subfascial technique in my opinion.  A low profile implant is used and the special subfascial plane is used to create aprojecting natural appearing tear drop shape.  Also after several surgeries you are much better off with subfascial placement for support. 

Of course you can downsize your implants.

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It is always possible to downsize your implants, but it may not always be the right thing. In your case, you mention that you previously had 400cc anatomical breast implants but was not satisfied with the size. 450 or 500 cc moderate plus implants will not be much bigger than the 400s you had before.

Ask your surgeon to place several temporary sizers during surgery to help you achieve a nice balance and result you are seeking.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 245 reviews

It sounds do-able

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The thing you need to understand about sizing of implants is that, in my opinion, THE most important thing is the diameter of the implant. I size the implants based on this principle. Essentially, you want fullness in all quadrants.

Additionally, as implants get larger the diameter goes up while the projection may not change, or change very little. Therefore, you should see how the various sizes of implant look on your chest wall- be sure there is nice cleavage, nice lateral fullness, nice round full lower pole fullness, and not too much or too little upper pole fullness.

Your doctor was wise to discuss a pexy with you. Depending on how you heal, you may or may not need the lift. One option would be to wait about 9 months to see how the breasts look and then decide on a lift at that time. This is something olny you can decide in consultation with your surgeon, who has the benefit of exam.

Downsizing can pose several problems.

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I have put in large, 700 to 800 cc, implants on a few occasions and they do look somewhat "done". However , that is what those patients wanted. You say that the anatomical first pare you had looked real but just too far apart. I think this emphasizes the point that the most important dimension in breast augmentation is the diameter of the breast. A good size will fill the diameter of the natural breast on the chest wall. We also should consider the width of the sternum ( breast plate). You cannot violate the muscle next to the sternum, so some people will have limitations on their cleavage for that reason as well. Ultimately you made two changes: size and shape, when you went from 400 to 700. In my experience the anatomical implant looks somewhat smaller for the same stated volume because it is distributed differently in the pocket. Also, now that you have much larger pockets, the smaller implant will move around a lot more and a modification of the pocket may be advisable. As you can see, this is not an easily resolved issue. And of course I am speaking somewhat theoretically, since I have not had the opportunity to examine you. I hope you are satisfied with your Board Certified plastic surgeon. The honest answer to your question is, "Yes ,it is possible to get pretty breasts that look real. But in no way could anyone guarantee that." Sorry to be so blunt. Best wishes

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon

They can be downsized.

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I agree with your doctor. They can be made smaller but you might need either a nipple reduction or a small pexy at the same time. Without seeing any photos, it is impossible to say. This is one of the most common problems -- patients want big then when they see what big is they want a more natural or smaller look.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 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.