Can I downsize by 50-100cc? Currently 425cc moderate profile, under muscle. How long will recovery be? (Photo)

Question

I had my first BA 1.5 years ago. I have consulted with my original surgeon about downsizing, and she said that I can downsize about 50-100cc without having to revise the pocket (which she said she cannot do). I am wondering if I will notice much of a difference with such a moderate change in volume. I am concerned that I will have the same appearance but feel saggier. I am 5'6, 130 lbs. I am currently a 32DDD and would like to be a 32D or DD.

Robert M. Lowen, MD · Answer

If a patient is a 32, then they need a smaller increment of fill to make significant changes in size.
Most patients who are 32 band will be a small C with 325 and a small to medium D at 425.  Since you are a DDD, it implies that you have a lot breast tissue to start with. However, your photos seem to be more like a D than a DDD to begin with. This may not apply to you, but we have consistently noted that Victoria's Secret bras overstate real cup size by one to two cups.  Women who are 34 or 36 sometimes say they are wearing a 32 Victoria's Secrets bra, which would bump them up 1-2 cup sizes automatically.
In any case, a reduction in volume to 325, 350 or 375 should provide a noticeable difference, more pronounced at 325.

Jed H. Horowitz, MD, FACS · Answer

hello majormum  Patients will feel sore and tired during the first 48 to 72 hours following surgery. During these first few days, the patient should engage in light activities, refraining from lifting or raising the arms above the head.
  
Swelling and bruising will subside during the first week after surgery and will be controlled by pain medication. The initial surgical tapes will be removed a few weeks after surgery during a post operative visit. Patients typically may return to a work a few days after surgery (only a light workload during the first two weeks). Showers are permitted on post op day #3 if there are no drains.
  
Scars will progressively fade throughout the first year following surgery. #recovery #healing

Urmen Desai, MD, MPH, FACS · Answer

I would not recommend it because downsizing by only 50-100 will not result in a noticeable difference.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. It seems like you have a nice result and I am sorry you are not happy with the outcome. It would be helpful if you could state more specifically what you do not like and what your goals are. This would help to determine what could be done to improve the result. If you want to drop some of the volume but want to retain the width of the implant, you could consider a lesser projection, which would likely not require any change in the pocket. If you want to keep the same profile and downsize, then this is going to be a less wide implant in the pocket that is already defined by the previous implant. This will cause some mobility of the implant and in that case I think you would benefit from some alteration to the pocket. This type of revision is very dependent on what your overall goals are so I would make sure you review that in detail with your chosen board certified plastic surgeon.Best of luck!

Gerald Minniti, MD, FACS · Answer

Hello,It's refreshing to here a surgeon being honest about her abilities, but doesn't that make you wonder whether your surgeon is an ABPS certified/ASAPS member surgeon? Regardless, your breast are already exhibiting mild dropout, so the pockets would need to be revised to achieve a great long term result. I think you should find a revision breast specialist. Best of luck!

York Jay Yates, MD · Answer

Changing to a smaller implant should be an easy endeavor for you with very little downtime or pain.   For a significant change in cup size, go closer to 100 cc smaller.   In this case, you will need your pocket modified and likely supported inferiorly.  This can be done with heat, sutures, synthetic support or a combination.   In my hands I would typically use a "popcorning" technique with cautery to shrink and tighten the capsule specifically where I want it and support that position with capsulorrhaphy sutures.

Nathan W. Patterson, MD, FACS · Answer

Certainly you can downsize and I would recommend dropping at least 100mL in volume.  Reducing the pocket to fit the smaller implant can be accomplished with a cautery technique, a suture technique, or a support material technique (such as ADM or mesh).  It might also be worthwhile considering raising the inframammary fold as well with these same techniques.  As there are many qualified surgeons in your area, I would advise a second or third consultation so that you are comfortable.  Best of luck!

Farbod Esmailian, MD · Answer

Generally, you would need to down size by about 100 cc to see a noticeable difference.  50 cc is really negligible and would not change your cup size much.When the implant dimension are changed, there is usually a need to tighten the pocket or perform what is called a capsulorrhaphy.  If you surgeon is unsure of how that is to be done, I would recommend you seek a board certified plastic surgeon for a second opinion.Hope that helps.

Daniel Barrett, MD · Answer

Dear MajorMom,if you aren't satisfied with the results of your surgery then I would suggest you to consult your plastic surgeon or ask for a second opinion in case that your plastic surgeon can't provide you with the desired look. Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
  
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
 Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
 Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
 You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Christopher J. Morea, MD · Answer

Thank you for your question and providing photos. You appear to have a very nice result. That being said you can downsize if you feel you are to large. My only concern is that you already have a moderate profile implant which is the smallest volume for the breast space. I believe it is important to place an implant that fits your chest dimensionally well. I would recommend you downsize the 100cc's so you see a difference. I hope this helps and best of luck

Can I downsize by 50-100cc? Currently 425cc moderate profile, under muscle. How long will recovery be? (Photo)

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