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

Question

I'm 19 years old, and I currently have 1300ccs over the muscle, I got them done on April 12th 2017, I've come to hate how they look and feel, I'm looking to downsize to achieve my goals( picture in white bikini.) but I do not want a vertical scar from the lift, a lot of the doctors I've had a consult with .want to do a standard lift. Please advice me on what can be done to get me the results I want and if a lift around my areola would suffice and how many ccs I would need, I'm 5ft10 and 138 lbs

Donald R. Revis Jr, MD · Answer

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!

Paul E. Chasan, MD, FACS · Answer

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.

Ronald J. Edelson, MD · Answer

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.

Anita Patel, MD, FACS · Answer

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.

Dallas Buchanan, MD · Answer

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!

Josh Olson, MD · Answer

I'm sorry to hear you are so young and ended up with such large implants. As you can see the skin stretch especially being as thin as you are is severe and there is no way to improve this without some sort of lift. A donut lift would not be a good option with as much skin as you have and it will make the shape even worse. I personally would recommend taking the implants out or draining them then after a couple of months replacing them with much smaller implants int he 600cc range with a lift. Looking at your wish pics I fear you have a misunderstanding of what breast implants can do. Without seeing your before photo it is difficult to assess the amount of breast tissue you had but many of your wish pics show women who likely had larger breasts to begin with and went wist implants under 6-700 ccs, no where near 1300 or even 800. Best of luckJosh Olson MD

Daniel Barrett, MD · Answer

Dear Lollypollylolly,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. Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Urmen Desai, MD, MPH, FACS · Answer

Yes, I would recommend a lift and implant.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Mathew A. Plant, MD, FRCSC · Answer

Unfortunately your skin has been stretched by the implants to the point that you'll definitely need at least a vertical scar if you want to downsize, you might even need a full anchor lift depending on your measurements and the size of implant you choose. The only way to know what you'll really need is through an in-person consultation with a board certified plastic surgeon with expertise in revision breast surgery. Best of luck!

Malcolm A. Lesavoy, MD, FACS · Answer

Congratulations on now wanting to have somewhat realistic breast appearance.  It is difficult to determine if you need a lift and implant or just a new implant without an examination.  It may be possible to just exchange your implants and do a "tape" breast lift.

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

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