Implant downsize and revision? What do you suggest?

Nineteen years ago I got textured 400 cc mentor implants (sub-glandular) which currently make me a 34DD. Originally I was a slightly droopy 30 4B and I really only wanted to be a 34C and perkier. I feel the current size/shape makes me look matronly. I would like to go at least 1 cup to 1 1/2 cup smaller. I would like to look as natural and perky as possible. I am 61 years old. Any suggestions on implant size, implant type and procedures? Specifics would very much be appreciated.

Doctor Answers 6

The right size for you

It is very difficult to determine the best implant you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants.  

Downsize

I certainly understand that DD after 60 is no fun. Your concerns are legitimate and deserve serious consideration. The best is a careful detailed consultation. 
There is every reason that you can be helped.

Richard Sadove, MD
Gainesville Plastic Surgeon
4.8 out of 5 stars 19 reviews

Implant revision

You would have to be seen in present be properly evaluated. Downsizing can be a bit tricky to gauge exactly the volume that you desire.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Implant downsize and revision? What do you suggest?

Without posting photos NO way to guide you! My guess is smaller implants with a lift. Best to seek in person opinions.

Implant downsize and revision? What do you suggest?

Thank you for the question. Online consultants will not be able to provide you with specific enough advice to be truly helpful.
 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 be necessary.  
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 and perky” or “down a cup size” 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, and the attached link (dedicated specifically to downsizing breast implants surgery concerns), helps. Best wishes.

What procedure for me

 Without photographs I'm only guessing what I would recommend. Based on your description of wanting to look smaller, I would remove 200 mL from your implant making it about 200 mL big and using a high profile contour. You'll probably likewise need some internal capsule suturing as well as an overlying breast lift in order to accomplish her goals. I would recommend you see a board-certified plastic surgeon in your region with experience in cosmetic breast surgery. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.