Follow up question. Will I need a lift if I go from 525 cc moderate plus silicone to 400 cc high profile? (Photo)

A donut lift widens your areolae from circumferential tension and can result in unsightly scarring, so in my opinion I think it’s best to avoid. You currently have a lot of upper pole fullness at the top of your breast which will definitely diminish with a smaller implant. High profile implants stick out more but they are a lot narrower, which means you’ll lose some cleavage as well as height. You may want to consider the same moderate plus style but in 400 cc. You could also consider removing skin from underneath your breast, along the inframammary fold, if the nipple appears a little high after you downsize. This scar is pretty well hidden. When I do cases like this, I always use sizers during surgery to determine which profile implant looks the best in order to avoid additional scars.

You could likely get away with just a periareolar/donut lift. You appear to have good skin quality.
A full vertical mastopexy might be more necessary in 10-15 years but you'd likely get a good result without it right now. You don't want to try to lift or overtighten too much with a donut lift - it can cause flattening of the breast and tends to lead to more areolar stretch overtime -even with permanent sutures. At some point the vertical scar is going to give better long term shape.

The question of whether a lift will be necessary after explant or downsize depends on a number of factors:

-Age of the patient- Younger skin has greater elasticity.
-Degree of pre-operative sagging- If you are sagging before the downsize/explant...the ptosis will only worsen.
-Age of implants- Implants which have been in place longer have had a greater opportunity to stretch the skin envelope.
-Implant size and degree of downsize- The less difference in volume the less likely you will have loose skin to contend with post op.

All of these factors contribute to the decision of whether or not a lift will be necessary. Some patients will definitely benefit and others are borderline candidates.

It is also important to remember the procedures can be staged which can allow for an evaluation of the post op look before committing.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Based on your pictures, you probably don't need a lift.
Currently, you nipples are well above your inferior mammary fold. Even if you exchanged your implants from a 525 to 400cc high profile implant, your skin will not sag significantly over your implant that would necessitate needing a lift.
When I discuss with patients the need for a lift procedure with an exchange for a smaller implant, or even removing the implant completely, I mention there are a couple factors that play into that decision. Those factors may include, how elastic the skin is currently, how many years the patient had her implants, how large their current implants are and what size they are exchanging for.
For someone who is downsizing 125cc, with good elastic skin, and only had their larger implants for a couple of years, my opinion would be that you do not need a lift procedure.

Hello ,
Thank you for sharing you concern.
When downsizing from 525cc moderate plus silicone implants to 400cc high profile, the need for a lift largely depends on your existing skin elasticity, nipple position, and breast tissue support. High-profile implants provide more projection and less width, which may help slightly with upper pole fullness but won’t compensate for any laxity caused by downsizing. If your nipples sit at or below the inframammary fold or you have noticeable sagging post-op, a lift — potentially a periareolar (donut) lift — may be necessary to achieve a youthful, lifted contour. While the donut lift hides scarring around the areola, it’s best discussed with your plastic surgeon, as implant downsizing alone often doesn’t correct ptosis.

It is difficult to say for sure without measuring in person, but the angle of the photos lead me to believe that you are already a borderline lift candidate. If you downsize the implant at all, it very well may push you into the category of needing a lift for sure. If you are still borderline (mild ptosis or low nipple position) then you might be able to do the donut lift only. However, keep in mind that sometimes trying to get away with a donut when a lollipop is needed can lead to a thickened scar that is not very well hidden anyway. It is best to let your surgeon determine which lift pattern is best, unless you are willing to tolerate a slightly lower nipple position. The other option if it is a borderline call is to simply do the exchange and see how you feel about the nipple position postop. Sometimes a small donut lift can even be done under local anesthesia in the office.

The answer to that question really depends on what your goal for appearance is. If you are looking to. have a relatively natural look then you would not likely need a lift. Your current implants are too large (and specifically wide) for your chest which is why they have compressed horizontally and appear oval rather than round. If you were to downsize to something in the 400 range that properly fits your base width then you would have a nice, natural result without needing a lift. If looking very full at the top and augmented is your goal then you may benefit from a small lift depending on the exact profile of implant you end up going with. I’d suggest having a consultation with a local plastic surgeon with expertise in breast revision to be examined and get a better sense of what your options are

Thank you for your question. I do not think you will need a breast lift with your implant exchange. Your PS can do something to shrink your implant pocket at the time of surgery. If you want to tighten the skin envelope you could have a periareolar skin resection. I hope this helps.

Thank you for submitting your questions and photos. Typically, when you decrease the size of your implants and change the profile to a high profile, it usually means you will have a narrower implant. It is very common to also need a breast lift in order to tighten up the breast skin so that the narrower implant does not misshapen the breast. You will need to be evaluated by a board certified plastic surgeon to see if an areolar incision pattern would narrow the breast enough for the smaller implant. Unfortunately, this incision pattern can help raise the level of the areola and decrease its size, but does not tighten up the lower pole of the breast enough. You may require a vertical incision to accomplish this. A plastic surgeon can walk you through all of these options. Good luck and thanks again for reaching out.

Not necessarily but it’s important for the surgeon to determine the location of your nipple in relationship to your bottom breast fold, and the distance from your nipple to your bottom breast fold (determines expanded lower breast pole skin). These findings help determine if you have excess skin that needs to be removed necessitating a mastopexy. All the best!