Revision for Downsizing Implants. If I knew then, what I know now - I would never have gone this big! (Photo)

Have had implants for 20 yrs with current ones for 7 yrs - 600cc High Profile Gels behind muscle. I'm 47 yrs old, would like to downsize a bit by 150 - 200cc to look less full but keep same shape. Started with 32 A, no sag, no children, very lean. Worried may sit too low with smaller implants prefer to sit a bit higher. Can I achieve this by tightening the pockets without a lift? Would staged surgery without implants for 4 months give better results? Should I stay with high profile?

Doctor Answers 8

Implant exchange after breast augmentation

s for posting your question. I am happy to try and help you. It is important to remember that a board certified plastic surgeon will be your best resource when it comes to an accurate assessment of your situation, and concerns.

Having said that, changing your breast implants for similar dimensions but going larger may or may not require capsule work to be done. It really depends on how tight or restricted your breast implants are now. If they are luscious and move beautifully, then the implant exchange should take about 20 minutes. If they are restricted do not move well, then you have a tight breast pocket and some revision work will need to done on the pocket. It is typically not as involved as the CC patient type capsule work.

So if they move you should be good to go. If not, then you may need a bit more work. Remember that in your size range you will need to go about 100-150 cc to notice a difference.

BTW, you have beautiful result and 400-450 would be really nice without any pocket work.

Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

Ashburn Plastic Surgeon
4.8 out of 5 stars 33 reviews

Can I downsize without having a lift and still look great?

Thank you for your question and photos.  No online reviewer can diagnose or make treatment recommendations without more information and an exam.  In my practice a patient who has had implants for two decades and is in their 40's has in my opinion a slim chance that the pocket and skin will shrink on their own and it is more likely that one would end up with a smaller implant in a loose pocket with sagging (the rock in a sock deformity).  I would recommend starting with a with a face to face consult with a Board Certified Plastic Surgeon who has experience in breast surgery. During your visit your surgeon should be evaluating your health to determine if you are a good surgical candidate and examining your tissues to get a sense of what type of procedure your tissues will allow. Only with a hands on exam can this be determined. During the consult you and the surgeon should be understanding of the goals and realistic outcomes of your choices. Be sure to see plenty of before and after photos to get an idea of the range of patient experience of your surgeon. Once an exam and opinion is rendered then you can decide if surgery is right for you. Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 23 reviews

Breast implant revision

You have a lot of photos up so I"m not sure which ones are your current breasts, but typically the skin will shrink back if you go down 150 cc's from 600, and not look too droopy. But since they are smaller they will seem like they sit a bit lower. Tightening the pocket may help if they are already a bit bottomed out but otherwise it probably would be of no benefit for you. 

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 97 reviews

Downsizing and pocket adjustment

I think with a modest reduction in size, the skin envelope should adjust accordingly.  The implants in place are large, and it is possible that you may need the internal aspect of the pocket sutured to keep the implants in an appropriate position.  It appears from the photos that the distance between the fold at the bottom of the breast and the nipple is slightly elongated - this will need to be evaluated by your surgeon at the time of your consult to determine whether it needs to be addressed.

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 5 reviews

Implant downsizing

Downsizing of implants is an option. Itis hard to predict how the sk in will react, but if you do not go too small, they maybe ok and not need any sort of lift.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Downsizing Implants

An in person exam is essential to answer your question. That being said, a downsize of 100 cc's or so with internal pocket adjustment is possible.


David Shifrin, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 165 reviews

Revision for downsizing

If you only wish to downsize by 150-200 cc, then I doubt you will need to revise the pocket and I would not recommend a staged procedure.  Based on your goal pics though, I would suggest you consider downsizing by more like 150 than 200.   Having said that, I would suggest using a different profile than the high profile so that you can get a wider base width and still fill the size of the pocket--this will eliminate the need for tightening the pockets inferiorly (at the base).  You may wish to tighten the pocket medially (in the cleavage area) just slightly to give you the wider cleavage you seek.  An exam in person with a plastic surgeon will give a better idea.  Best of luck!

Jeffrey A. Sweat, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 44 reviews

Revision of size

From the photos you provided, I would think that you could reduce the size and profile to moderate plus and do capsulorraphies (close the capsule off) both on the side and bottom and not have to do any skin removal. The newer gel implants that are more filled would collapse less at the top giiving the appearance you describe.  Allergan Inspira and Sientra style 107 fit the bill. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 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.