Unhappy with 305cc breast implants and want to remove / downsize to smaller implants. Will I be left with sagging? (Photo)

Smaller implants measured to your frame should not require a lift based in your photos. The internal pockets may have to be adjusted from the inside.An exam and consultation with your/a plastic surgeon is recommended to confirm this as well as discuss your options and expectations.

I recommend explantation and 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 and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Dear Van1289,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Based on the photo, you may not need a breast lift even after downsizing. The internal pockets may be readjusted to fit the smaller implants and should still give you great results after recovery. Your best resource of information would be your board certified plastic surgeon as he/she knows your condition best.

Thanks for writing,The second operation will be much nicer pain wise, but it can be more complicated.  When you down size there may be some stretched skin that might need to be tightened. I use a tailor-tacking technique to make that decision on the O.R. Table. Good luck Stephen M. Davis, MD, FACS
Green Hills Plastic Surgery
Certified: American Board of Plastic Surgery
Member: American Society for Aesthetics Plastic Surgery
Member: American Society of Plastic Surgeons
Member: RealSelf Hall of Fame

You could consider going down to 200 cc's and going with a lower profile. Your surgeon could also tighten your pocket internally, and probably avoid any lifting. Please discuss your concerns with your surgeon. Usually, a revision surgery is less painful that the first.

Dear Van,Revision breast augmentation is usually much less painful with a shorter recovery period and less swelling.  You have several issues with your breasts right now.  Asymmetry, uneven heights, nipple/areola facing slightly laterally... many of these issues were probably present preoperatively.  A complete physical exam would answer most of these questions and allow for a proper surgical plan.  I agree with dropping down in size (200cc's sounds like a good size) as well as changing to a moderate plus or moderate plus X implant.Best of luck with your decision

The second procedure is typically easier than the first. Profile, in addition to size, matters a great deal. Nipple heights, if variant prior to surgery, would be accentuated by augmentation. Sagging cannot be estimated without a physical examination.

Thank you for the question. In the end, exactly what operation you should undergo and what type/size/profile of breast implant should be utilized will depend mainly on what you are trying to achieve (in other words, what your goals are).  In other words, there are no "general recommendations": every patient's  situation is unique and care needs to be individualized.


 Downsizing of breast implant surgery (sometimes) adjustment of the breast implant pockets (capsule adjustments) may be necessary to achieve the outcome you are looking for. Breast lifting may or may not necessary.  Much will be dependent on your physical examination;  specifically, factors such as the amount of redundant skin, quality of skin elasticity will be important,  and how much you wish to downsize.


Generally speaking, the best online advice I can give to ladies who are considering revisionary (downsizing) breast augmentation surgery is:


1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.


2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural look” or "down a cup size” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. 


3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.
I hope this helps. Best wishes.