Is it possible just to exchange my implants without lift? (photos)

Question

So I have Natrelle high profile silicone implants 600cc (I have a periolar incision under the muscle/Keller funnel) and I would like to exchange them for Mentor gel high profile 450cc. Can I just get a inflammamory incision to remove my implants and put the new ones in without lift? Or will that look bad? Will it also be better to go 500cc to cover enough surface area to cover any gap? Will there also be a noticeable gap? What can I expect? Should I use different implants instead to reach my dream pic?

Jed H. Horowitz, MD, FACS · Answer

Yes it is possible #downsize to smaller implants and also alter the positioning; if possible. However, a Breast #Lift to #tighten loose skin is usually recommended to better optimize the end result. 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. Other factors which contribute to the outcome are #size, #shape, and #profile.  The #profile is determined by the amount of #projection versus roundness that the you desire, as well as the #size of the implant and size of your chest. Also, the placement or incision location will also have an effect on profile.  More women tend to choose silicone breast implants due to the natural feel and appearance. Silicone implants are now made of a cohesive gel which are anti-leak even when cut. Look and feel like natural breasts due to the cohesive silicone gel material. New generation silicone gel implants are far superior than those used in the past and have a proven track record of safety. Silicone implants have gone through more testing than any other medical device and are the preferred choice for over the muscle implant placement. Also, the right implant for the revision is contingent on shape of body and your desired outcome. Another element to a satisfying result of your #augmentation is realistic #expectations. Talk to your surgeon at greater length and be sure to view before and after pictures and reviews beforehand to gain more reassurance of the procedure.

Robert W. Kessler, MD, FACS · Answer

The answer to your question is that a modest reduction of implant volume will not lead to the need for a lift. My concern is that your dream pictures are in garments and I am not clearly seeing a difference between what you have and what you want.This decision would require a formal conversation with a board certified plastic surgeon to clearly understand if what you are asking can be achieved.The procedure you mention is very reasonable and can be done. The bigger issue is if it is the right thing to do for you. Smaller breasts with mild skin laxity may not be the right path for you.Seek out a board certified plastic surgeon to evaluate you and discuss these issues in more detail.Good luck and I hope this was helpful.

Steve Laverson, MD, FACS · Answer

Your questions are the exact same questions we plastic surgeons ask ourselves every day.  Unfortunately, your skin elasticity, propensity to scar, possibility of capsular contracture, and other future events cannot with certainty be predicted in advance.  We can however control risk based on what we know. 
If you want the breasts to come together in your mid-line as they now do, choose implants that are the same width.  Volume (450, 500, 600) matters less than dimensions (width and projection) of your implants in this respect.  A high profile (high projection) implant that is smaller volume than another high profile implant (600 to 450) will be smaller both in projection and in width.  To keep your breasts together (width) and go smaller (volume) requires either a lower profile device (less projection but same width) or lateral capsulorrhaphy to move the smaller high profile implants toward your center.  That latter maneuver however may position your nipples eccentrically on the breasts, and would mandate post surgical compression bra for a period of time to prevent implants from lateralizing.  I would also recommend textured surface devices if you insisted on narrower high profile devices and "cleavage," and you insisted in sub-pectoral positioning, because if they're smooth surface, your muscle may tend to lateralize them over time by dynamic compression of the devices against your curved ribs, and by gravitational influence.  
I like avoiding a new (infra-mammary) scar when possible, but re-entering the areola region may pre-dispose you toward capsular contracture, so this is a decision between you and your surgeon.  Replacing implants through the existing areola scar doesn't obligate you to another breast lift.  Also, if you already have the areola scar, re-doing an areola lift may tighten your skin envelope around smaller devices without any new scar.
Discuss all of these with your surgeon.  You look pretty good now, sometimes, adjusting to your perceived imperfection (adjusting to the known) is preferable to embarking on a change with uncertain outcome.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. What is the motivation for the implant exchange? I think that you have a good result and unless you just want smaller implants, then I would leave things alone. Sometimes the enemy of "good" is "better." Don't look at a picture of someone else's implant size and assume you can have that result just by copying their size. This is faulty thinking and should be avoided. If you do want to downsize your implants a significant amount, then you run the risk of needing additional surgery to achieve your desired goal. This decision would have to be made after an exam and consultation with a board certified plastic surgeon and depends on multiple factors, including your overall expectations.Hope this helps!

Yuly Gorodisky, DO, FACOS · Answer

Your current picture looks great. Unless you are having problems with your implants, or if they are too heavy for you, I probably would not change them at all.  Every surgery has some risk of complications and the outcome must outweigh the risks to justify having this done. If you still want to go to a smaller implant, you should be ok, but if the implant pocket is made smaller to create the fullness you like on the top, it may make the nipple sit too low and will not look good. Then you may need a lift.

Milind K. Ambe, MD · Answer

Thank you for your question and photos.  You are likely able to just get by with an internal capsulorraphy (internal tightening of the pocket) with exchange to different implants using an inframamary incision.  Seek in person consultation appointments with Board Certified Plastic Surgeons in your area.  Best of luck to you

Dan Mills, MD · Answer

By going from 600cc to 450cc you are essentially dropping down one cup size. I agree with my colleagues that by using an inframammary incision, you have more freedom to perform work on the breast pocket (although this may be achieved with your preexisting periareolar incision too!). A smaller implant means a narrower width, and in order to maintain the amount of cleavage you have and still desire, it may be necessary to adjust the pocket (capsulorrhaphy). If you did not, you would still have a good result, but you may have more space between the breasts and they may not sit as high as you show in the 3rd photo. That being said, why are you looking to downsize your implants? Whatever you decide, or if you go for a consultation to answer your questions in person, make sure your plastic surgeon is board certified! I hope this helps. - Dr. Mills.

Robert M. Kachenmeister, MD · Answer

Thank you for reaching out and posting photos! From looking at your photos, it does not seem that you would need a lift if you removed and replaced, but ... an in person consultation to discuss sizing, pocket revision, skin elasticity and more would be best! Be sure to visit experienced Board Certified Surgeons and be on the same page with your surgeon about our end result expectations! Best of luck. Dr. Kachenmeister

Allen M. Doezie, MD · Answer

If you wish to have your implants replaced with smaller ones you are definitely able to do that. You should have a pocket revision done to match the new smaller size of your implants since you are wanting to downsize a whole cup. From your pictures it looks like you do not need a lift, but have an in person consultation just to make sure.

Arian Mowlavi, MD, FACS (license on probation) · Answer

You should be ok with a 100 to 150 cc downsizing, regardless of implant company or incision approach. I agree with you that your breasts are a little to large for your frame.

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