500cc gummy implants and want to go smaller - Do I need a lift or just new implants? (photos)

If the size is reduced to that extent, it seems that it may not be necessary to lift. Lifting (mastopexy) leaves a scar and should be done carefully only when absolutely necessary. However, depending on the situation, it may be necessary to modify the implant pocket slightly.

Yes, based on your photos alone and goals you absolutely need a lift to achieve a harmonious looking breast after a lift. I would recommend seeing a board-certified or board-eligible plastic surgeon with aesthetic surgery training and experience to tackle this type of problem in a safe and efficient manner. Best of luck!

Dear Catalina,
Based on you photos it appears that your nipple position is too low to avoid a lift when you remove your larger implants and put smaller ones in. The breast/skin envelope will be more lax and droopy when you change to smaller implants. If you have "gummy" implants, it is important to know if they are textured or not, and with smaller implants, the pocket will likely have to be modified to be smaller.

The technique I recommend is explantation with lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if injured during your previous surgery. Later, fat transfers or small implants can be placed.

Best Wishes,

Gary Horndeski, M.D.

Dear CatalinaWen,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I would suggest going smaller and going with smooth round implants for a better shape. An examination is needed to see if you can have a lift. Measurements are also needed to see if a lift would be helpful. Smaller would be more comfortable and less heavy on your neck and shoulders.

A full consultation would be necessary to know for sure. This will assess your tissues, implant capsule, etc. Based on the implant volume and pictures, I believe you would do best with a lift at the same time as implant exchange. I recommend you work with a Board Certified Plastic Surgeon.

Based on the posted photos I would recommend not doing exchange but trying first a donut lifting to even the areolar complexes. Or even a unilateral L- shaped lift. If still unhappy then consider smaller implants at 350 cc with full lift. Best to in person or virtual consult with...