Downsizing from 1300cc overs to 800cc silicone, what would be the best way to do this?

Good afternoon!
I work with a lot of XL augmentation patients and in general when going down in size I would recommend the following:
1) pop your implants in the office and drain out the saline with a needle
2) compress your skin tightly for three to six months to allow for maximum shrinkage of your stretched out skin
3) donut mastopexy (no vertical), under the muscle, 800cc High Profile silicone gel implants
I have attached a link to my XL Breast Augmentation photo gallery for your review- hope it helps!

A significant portion of my practice is dedicated to performing revisionary breast surgery.  In your case, the best course of action would be to use a needle to deflate both implants.  I takes approximate 5 minutes in the office and allows the skin to be off stretch for approximately 3 months.  After 3 months, you would need to reposition the implants in the subpectoral location and perform a lollipop mastopexy. For you, there is absolutely no way around performing a vertical scar.  I have seen so many failures in my career in patient's attempting to perform a periareolar or doughnut lift in cases is much more mild than yours resulting in very poor outcomes.  The vertical scar often heals very nicely, and after a year, it is barely noticeable. Best wishes to you.

I agree that the idea approach would be to include a lift as wel,  but you don't have to.  Simply replacing the implants with smaller one will be better than what you have now.  If you decide later to have them lifted that's possible as well.  

You're a beautiful girl and I agree this implant choice was a mistake. Not only is the implant size extreme, but placing that size implant above the muscle puts extraordinary stress on your skin and your own breast tissue. Actually, I am really disappointed a plastic surgeon would do this at all. (This leads me to so many questions- Was the surgeon a plastic surgeon? Was it a board certified plastic surgeon? Are they stacked implants? Was it done outside of the US?) It's our duty as plastic surgeons to keep our patients safe, and at this stage I would not even recommend replacing the implants just yet. I would recommend removing them right away and allowing your tissues to heal and shrink back down before entertaining any additional surgery. At your age, if your tissue is in good condition, you can expect it to contract after the implants are removed. How much it will contract, only time will tell. Once the skin has contracted, you can be then be re-evaluated to see if a lift is needed, and if you want to increase the size, I would recommend placing the implants below the muscle, and a smaller size. I realize this sounds conservative, and probably not what you want to hear, but I think it would ultimately yield the best results. Also, please note this recommendation is based just on the photos, and for an actual plan or recommendation, an in person consultation would be required. 

Thank you for your pictures and questions. Placing such large implants in front of the muscle has led to severe stretching of the skin and a poor outcome. I am sorry you went to a surgeon who allowed you to make this choice as it is going to make things very hard on you moving forward. Despite what you hope for, there is going to be no easy way out of this or assurance of a good outcome. If you are wanting to downsize from a 1300 cc implant to 800 cc, then you are certainly going to need a lift of some kind and I can almost assure you a peri-areolar lift is not going to work for you. You are likely going to need a full anchor lift. The only way to know for sure is to go to a consultation with a local plastic surgeon, but this time make sure he or she is board certified by the American Board of Plastic Surgery as I am relatively sure that when you chose last time, you did not make sure of that or you would have never ended up with this result.Best of luck!