Downsizing twice? (Photo)

Question

How difficult is it to downsize from 550 cc to 200-300 cc when the implants have already been downsized from 700cc to 550 ( still being too big) a year ago? Will the Breast pockets under the muscle be too large for that small of an implant ? Would a lift help with pocket tightening ? No lift was needed during the previous downsize. Prior to implants I had little breast tissue. Thank you.

Matthew S. Kilgo, MD · Answer

Hello, While it is a difficult question to answer without performing a physical examination, substantial downsizing often requires reduction in the size of the internal pocket as well as the skin envelope. It may be helpful to change the implant projection to a lower profile with a wider base width to minimize the need for internal pocket revision. A large implant will often cause skin stretch, and the skin envelope will need to be tightened when downsizing the implant. This is accomplished with a mastopexy. I hope this helps.

Chet Mays, MD · Answer

Thank you for your inquiry!  Removing the implants and tightening the pocket would be an option for you.  Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals.

Ellen Ozolins, MD · Answer

Thank you for your question. A photo of your breasts in a bra is not helpful. However, since you've already downsized once, the breast pockets may be stretched and could be too large for the smaller implants you're considering (200-300cc), which might lead to implant malposition (shifting, sliding) or an unnatural appearance. Your surgeon may perform a capsulorrhaphy (pocket tightening) to correct this. This procedure involves suturing part of the pocket to make it smaller. You may need breast lift depending on how much skin laxity and sagging have occurred after further reducing the implant size. Your surgeon will assess the condition of your tissue and pocket size to recommend the best approach for you.

Gary M. Horndeski, MD · Answer

If at one time you 700 cc and are going down to 200 cc then you will need a lift. The technique I recommend is 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 (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

A photo of your breasts in a bra is not helpful. Theoretically, there is nothing wrong with a second reduction. Anything in addition to replacing with smaller implants that may be indicated is based on individual anatomy, which is best determined by physical examination.

Connie Hiers, MD, FACS · Answer

If you have minimally breast tissue, then a lift may not be safe. However, you can still go down in size and have your larger pocket tightened. Minimally invasive plasma energy with Renuvion can help to tighten your skin and is safe to your nipple. You probably cannot go down to 200 cc's from 500, but should be able to go to 350-375. Your first implants were much too large for your frame and tissue.

Mats Hagstrom, MD (license on probation) · Answer

There’s no yes or no answer to your question.
It depends on a number of variables.
Downsizing implants early after surgery on young people can typically be done without any significant problems.
The capsule will eventually shrink to accommodate the new sized implant.
 Downing on an older individual who had implants in for many years is a completely different story.
When this is the case, sometimes the pocket needs to be closed and the envelope needs to be adjusted as well.
If you didn’t have much problems with the previous downsizing and the next one should be fairly easy as well.
 There are a lot of very balls to take into consideration.
Sometimes the skin envelope needs to be reduced. Sometimes there is enough tissue elasticity to accommodate a smaller implant without issues. 
Best,
Mats Hagstrom MD

Downsizing twice? (Photo)

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