Reconstructing the capsule - is this too complicated?

Question

Hi! I am going to have my current implants replaced soon. They are 9 years old. I’d like to go down in size. My implants are too large for my frame. One of the things that I don’t like about my implants is how wide they are. I was told by one doctor that I could not go more than 1cm down in width otherwise it would create too much room which could lead to fluid and issues. I’m confused because I know people have breast reductions all the time. Is it just too complicated to revise the capsule area and this is his hesitation?? how do you typically handle this? Il looking to go down from 485 cc to around 490 cc. But if I keep basically the same width I feel like they will just look still too wide for my body and then not as full. So wide and flatter in a way rather than smaller overall. For reference my first set of implants were smaller and I’m looking to go back to that size so I know my body can handle the smaller size.

Laura Roider, MD · Answer

@Aimsee This is a great question! It is possible to go down in implant size but there maybe some adjustments that need to be made to the soft tissue of the breast (such as capsule work or a breast lift). 
Depending on the implant selected the current breast capsule will likely need to be tighten or partially removed (These procedures are called capsulorrhaphy & capsulectomy). Additionally, depending on your current anatomy and tissue quality some patients need a breast lift when they down size implants. This allows us to address the excess skin that was created by the larger implant. 
I recommend discussing your concerns of the implants being too wide with your surgeon and determining what options exist.

Milan Doshi, MS, MCh · Answer

Hi AimseeYou can downsize in both volume and width, but when the implant footprint is reduced, the existing pocket can become too wide, leading to malposition, fluid (seroma), or a “loose pocket” look if not addressed.
The reason for your surgeon’s caution is pocket control. When downsizing, the key step is capsulorrhaphy (internal pocket tightening) and, in selected cases, reinforcement (e.g., ADM or mesh) to match the new, smaller implant. This is different from a breast reduction, where tissue is removed and reshaped&mdash;here, the implant pocket must be resized precisely.
If your goal is less width and better proportion, it is achievable, but it requires:
Careful implant selection (narrower base, appropriate profile)Pocket revision to eliminate excess spaceConsideration of tissue quality and skin envelope
Without proper pocket adjustment, a smaller, narrower implant can indeed look wide and flatter or sit laterally.
This is a great question. I would recommend consulting with a board-certified plastic surgeon to further discuss your goals and evaluate you in person.

Reconstructing the capsule - is this too complicated?

Answers (2)

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