Creating a new pocket for implant exchange?

I
recommend explantation using The Bellesoma Method.  This will reshape your breast tissue creating
upper pole fullness without implants, elevate them higher on the chest wall and
more medial to increase your cleavage. 
Vertical scars are avoided, nipple sensation and the ability to breast
feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can
be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D. 

Thanks for the question. Changing implant sizes is quite common. If the pocket itself has nothing abnormal such as too wide, too low, too lateral, etc. then it's not necessary to do a lot other than make is a little smaller. I do occasionally use GalaFORM to help redefine the pocket and increase the implant's chance of remaining in the right position. GalaFORM is an absorbable mesh and gives great shape and support. If the scar tissue around the implant (capsule) has become abnormally hard or firm, a capsulectomy will usually be done and a "neo pocket" created. This is still under the muscle. I don't ever switch to a pocket above the muscle. Best of Luck!

Closing the pocket around a smaller implant in my opinion is the best option and the least amount of surgery. A second pocket would probably mean that you would be switched from under-the-muscle to over-the-muscle implant location, which would be less favorable.  Patients who want to be significantly smaller may also benefit from 2 operations: one to remove the implants and let the skin settle and tighten on it's own, and a second operation to insert a new smaller implant.

There are many reasons for creating a neo-pectoral or new pocket between the muscle and the existing capsule to place a new implant. Most of the time the procedure is performed when there are significant breast asymmetries caused by implant displacement or deformity. Sometimes one side will displace more laterally or inferiorly (bottoming out) or medially (creating symmastia or bread-loafing). Creating a new pocket can allow replacement of an implant into a more attractive or symmetrical position. 
Most of the time, however, a formal mastopexy is required in order to reshape the breast around the smaller implant. Of course, there can be many opinions about the best treatment. Please select a surgeon board certified by the American Board of Plastic Surgery and preferable a member of the ASAPS (American Society of Aesthetic Plastic Surgeons).

Its difficult to comment on any treatment plan without a formal consultation and physical exam.  Typically, I reserve a "site-change" or "neo-pocket" creation if there is something suboptimal about your current implant pocket.  For instance, for someone who has had implants for 20-30+ years and they present with bad scar tissue (capsular contracture) that has made the breasts rock hard, in those cases, I would create a new pocket to provide a new "virgin" pocket for a new implant that has not had any history of scar formation.  In this scenario, a new pocket is though to help decrease the risk of scar tissue recurrence.   Please visit with a board certified plastic surgeon to learn more about your options.  Best wishes,Dr. BasuHouston, TX

Thank you for the question.  Although it is possible to have breast implants replaced in the sub glandular position, I do not think that it is in the best interests of most patients to do so.  Generally, breast implants placement subglandular position can be problematic;  concerns such as rippling, palpability, encapsulation,  accelerated "sagging" of the breasts…may arise.
In other words, if at all possible, I would suggest keeping the breast implants in the sub muscular (dual plane) position;  this is assuming that an aesthetically pleasing outcome can be achieved with adjustment of the breast implant capsules…In the end, exactly what operation you should undergo and what type/size/profile of breast implant should be utilized will depend mainly on what you are trying to achieve (in other words, what your goals are).
 You are correct in that during downsizing of breast implant surgery (sometimes) adjustment of the breast implant pockets (capsule adjustments) may be necessary to achieve the outcome you are looking for. Breast lifting may or may not necessary.  Much will be dependent on your physical examination;  specifically, factors such as the amount of redundant skin, quality of skin elasticity will be important,  and how much you wish to downsize.
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. I have found that the use of words such as “natural” or "down a cup size” or "C or D 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 helps. Best wishes.