Can my right breast implant be exchanged for a smaller implant without loose skin?

Hello, I had my PIP ruptured implants removed in March 2012.  These were extra high profile 265cc in the left and 245cc in the left.  This made me a small C cup which I was happy with.  I had a breast augmentation 4 weeks ago.  My right breast was a cup size bigger than my left breast (A cup Right, AA cup left).  My surgeon said due to my small frame (rib cage measurement 23.5cm all around),  I had to have extra high profile.  I asked if I could have the same sized implants as I had with the PIP's as I was happy with the size, neither too small nor too big.  He said 285g is equivalent to 265cc and 255g is equivalent to 245cc PIP's.  I asked for  Allergan natrelle inspira implants 285g in the left breast and 255g in the right (the next size up from 285g) to make my breast symmetrical.  He said no.  He said the difference between my left and right breast is not enough to have different sized implants.  I asked again if he was sure because the two different sized implants made me symmetrical.  He said no, you need 285g in both breasts.  I listened to him.  I am 4 weeks post op.  I am a small C cup in the left and a large C/small D cup in the right!!!  I am so upset.  It is so noticeable.  All my friends have said they look silly and completely different sizes.  The right is fuller on the top and bottom and projects half an inch more than the left.  Will he exchange the right implant for the 255g like I had wanted for free?  Will I have loose skin?? Please help, I am so depressed, been crying everyday.  Thank you in advance.

Doctor Answers 10

Loose skin after changing to smaller implant?

I can understand your frustration. Your question about loose skin is a good one. If you have reasonable good skin elasticity and change to a slightly smaller implant, you probably will not have a problem with loose skin. 20 mL is probably not enough of a difference to stretch out most women's skin significantly or beyond its ability to contract. Obviously, this is impossible to predict with absolute certainty, though.

With regard to your asymmetry issue, I recommend not rushing to make any changes. You are still early out from your procedure and things are still healing. That being said, it is impossible for any of us to determine the best course of action over the internet. Discuss your concerns with your plastic surgeon. It is really important to communicate your dissatisfaction so that he or she can evaluate you and determine the best way  to proceed. If you feel like you would like a second opinion, set up a consultation with another board certified plastic surgeon. 

You will feel much better if you have a clear set of recommendations and a treatment plan for moving forward from a plastic surgeon. I wish you the best!


Michael Vennemeyer, MD

Southlake Plastic Surgeon
5.0 out of 5 stars 48 reviews

Different Sized Breasts

I had some trouble understanding your description.  However, now that you have had the procedure, you need to wait 3 months from the surgery date and then see how you are doing and then revisit the situation.  Remember that breasts are not perfect, surgeons are not perfect, implants are different, and some asymmetry is typical.  Be patient and trust your surgeon and see how if looks in a while.  Your breasts were not perfect when you started and almost certainly won't ever be perfect.  Take a deep breath and give the swelling a chance to subside.

Steven Holzman, MD
Austin Plastic Surgeon
5.0 out of 5 stars 9 reviews

30 cc and Increase in Cup Size

    The smallest conceivable volume at which a cup size increase is realized is 150 cc.  30 cc is not a noticeable difference.  At 4 weeks, there may be some swelling left and there may be some change during healing.  Kenneth Hughes, MD breast implants Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Breast asymmetry after implant exchange.

First thing is don't panic! It's very early to make judge. PIP implants had a different gel from your new implants as well as different dimensions and it may not simply be a matter of size. Sometimes in mild asymmetry one might use symmetrical implants and usually 20 to 30 g is not a very significant change in size. I suspect the best plan is to let everything settle down then reassess the situation with your surgeon, looking at the differences and how this might relate to the implant choice. A change of 30g or so would rarely give rise to loose skin (though may make little difference to the overall size of the breast).

Stephen Hamilton, MD, FRCS
London Plastic Surgeon

Breast Implant Symmetry

Hi, I understand your frustration. After surgery, one breast can swell more than the other temporarily. It is too soon to judge whether they will be the same size. After at least 4 months, you will have a better idea how symmetric  your breasts are. All women start out with differences in the size and position of the breast and even differences in the shape of the bones underneath the breast. In surgery, I sit patients up to assure they are as symmetrical as possible.

Michael Horn, MD
Chicago Plastic Surgeon
4.3 out of 5 stars 57 reviews

Size matters, but so does everything else!

Simply looking at the mass (grams) or volume (cc's) isn't enough to understand what's going on. Your surgeon is also considering the dimensions. Here are the numbers:

PIP 245 cc:        11.7 cm diameter, 3.0 cm projection

PIP 265 cc:        12.4 cm diameter, 3.1 cm projection 

Natrelle 255 gm: 10.0 cm diameter, 4.8 cm projection

Natrelle 285 gm: 10.5 cm diameter, 5.0 cm projection


Rather than evaluating only size, your surgeon must consider projection, diameter and size.



Your Natrelle implants project much more than your PIPs. Also notice your 2 PIP implants only differered in projection by 1 mm (negligible) from each other. So the 12.7 mm (half an inch) difference in projection you now notice is not due to incorrect implant sizes. Also notice that using the 2 different Natrelle implants would give a 2 mm difference rather than the 1 mm difference your PIPs had. So there's no way to directly convert the PIP projection to Natrelle projection.



Your new Natrelle impants are significantly smaller in diameter than your PIPs once again making it impossible to correlate the PIP diameter to Natrelle diameter. Furthermore, the difference between the 2 PIP's is 7 mm while the difference between the 2 Natrelle's is only 5 mm - again no correlation and negligible.



As you know the PIP size is measured in mass (grams) while the Natrelle is measured in volume (cc's) once again making direct correlation impossible. Furthermore, the difference between the 2  PIP implants is 7.5% while the difference between the 2 Natrelle implants is 10.5% - a much larger difference. Your surgeon probably could not justify placing 10.5% different sized implants based on your amount of preoperative asymmetry. Perhaps if Natrelle made 2 implants different by 7.5% (like your PIPs), he would have offered to use them.


By looking at all the numbers, you can see that placing different sized Natrelle implants may not have prevented you from having asymmetry right now. Your surgeon took into account your original PIP sizes, your dimensions and sizes 3 months after the PIPs were removed, and the implants available to him.


Furthermore, your breasts need time to accommodate to the new implants which are smaller in diameter, higher in projection, and slightly larger in size compared to the old implants. It will take time. I would wait at least a year before reevaluating the size and considering changing one of them. At that time, you and your surgeon will be able to make a much better determination of what size and dimension implants will be best.


You've been through a lot. Having asymmetrical breasts treated with PIP implants left you with 2 problems: dangerous implants and the need for more surgery. Fortunately, you no longer have dangerous implants inside your body - that's something to be happy about rather depressed and crying. You also can be happy that you're breasts have been enhanced to a size larger than your natural breasts like you wanted with safe implants - that's also something to be happy about. Unfortunately, you may have to wait before everything is as good as possible. 




Armin Moshyedi, MD
Bethesda Plastic Surgeon
4.6 out of 5 stars 21 reviews

Please send your pictures

The only way we can give you a reasonable answer is to a least view your before and after pictures.15-30 cc will not cause cup size difference.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

If needed you can have your breast implant exchanged!

First of all you certainly can have an exchange later but it may be simpler just to add some fat.  We don't want you to be depressed either.  Be patietn and listen to your surgeon.  He can also recommend someone else if you feel youneed another opinion.

Asymmetry After #BreastAugmentation Surgery

Without photos, it is impossible to be more specific, however, in your situation sometimes it is very difficult to create symmetry when you are starting with asymmetric breasts. That being said, if you have already had a symmetric result - your chances are much higher. Give it time, but it is possible that you need a smaller implant to achieve your "ideal" result. 

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 47 reviews

Difficult to get the size right with breast asymmetry.

That is a great response by Dr Holzman.  I am sorry that you are unhappy with your surgery and it is always difficult to get things right with a breast asymmetry.  Sometimes it is best to put the same size implants in, although I can see why you are upset since you were happy with your differential sized implants when you had the PIPs.

Since it is only 4 weeks, the advice has got to be that you leave things to settle for a few months.  If things remain unbalanced, then you need to have a discussion with your surgeon as to whether the risks of undergoing further surgery are outweighed by the potential benefit of getting a better size match with a change of implant. 

Good luck.

Jonathan J. Staiano, FRCS (Plast)
Birmingham Plastic Surgeon
5.0 out of 5 stars 20 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.