Removal of large implants, lift, and exchange for smaller implants - Will I need a lift to fix the skin? (Photos)

Question

Hi there, I’m 5’8.5, 27 years old, female, 118lbs. When I was 22 years old, I made the mistake of getting extremely large implants. I can’t quite remember the exact CC but I believe it was 670cc. I have horrible back and rib pain, trouble breathing, and my breast look terrible. My plastic surgeon ended up putting a larger one in the left side and a few months after the surgery, I believe the muscle tore. It turned purple underneath and looked pretty bad for a few weeks. Since then, the left one sits far lowers than the right. It‘s very obvious in photos. The skin is stretched and lots of rippling. It almost feels lile the implants flips if I lean down or move a certain way. They hurt all the time and like they’re going to rip. It hurts to not wear a bra but I can only wear sports bras. Anything else causes bad pain from the breast sitting on my ribs. I’m constantly having to lean back in my chair to catch my breath. My question is if it’s possible to downsize after having such large implants? I’d like to go down to a small C cup. I was a full B prior to surgery. Will I need a lift to fix the skin? If so, will I still be able to breastfeed in the future? What size would you recommend? I was considering 200-250cc low profile.

Mert Demirel, MD · Answer

Yes, it is possible to downsize after very large implants, but with 670 cc implants, pain, asymmetry, stretched skin, rippling, and one implant sitting much lower, this would be a complex revision rather than a simple implant exchange.
If you want to go from very large implants to a small C cup, you will very likely need pocket repair and a breast lift. The skin envelope has been stretched, and a much smaller implant will not fill the loose skin. A lift can remove extra skin, improve nipple position, and help reshape the breast around the smaller implant.
A 200–250 cc low-profile implant may be reasonable as a concept if your goal is much smaller and more natural, but the exact size depends on your breast width, tissue thickness, and how much natural breast tissue remains. Sometimes surgeons also use internal support, such as mesh or capsulorrhaphy, to repair a stretched or damaged pocket.
Breastfeeding after a lift is possible for some patients, but it cannot be guaranteed. The risk depends on the lift technique, amount of tissue rearrangement, nipple position, and scar pattern. If future breastfeeding is very important, discuss this clearly before surgery.
Because you have pain, breathing discomfort, possible muscle injury, asymmetry, and implant movement, I would recommend seeing an experienced revision breast surgeon soon. Ask about implant removal or downsizing, pocket reconstruction, lift pattern, internal support, and whether imaging is needed to evaluate the implant and surrounding tissues before surgery.

Gary M. Horndeski, MD · Answer

I recommend explantation with breast lift using the Bellesoma. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

From the photos and description of your concerns an implant exchange is recommended.  Smaller implants can be used to better fit your frame and alleviate some of the weight and stress on your body.  It does appear that a lift would be recommended for you.  The asymmetry can be addressed with the surgery.  I've included a video that discusses breastfeeding that I hope you find helpful.

Serkan Kaya Ekinci, MD · Answer

Hello, first of all, get well soon. I am op dr Serkan Kaya ekinci. I want some examinations from you. Breast MRI or high resolution ultrasound.
Is the implant intact? Do you have seroma or hematoma?
How is muscle integrity? Revision surgery Removal of existing implants.
Complete re-preparation of the pocket.
Reconstruction of the inframamari groove (IMF) and fixing it with sutures.
Lateral and inferior capsules.
Lower pole support with ADM or synthetic mesh (Galaflex, etc.) if necessary.
Placement of smaller implants (e.g. 200–250 cc).
Mastopexy in the same session.
3. If the muscle is really torn
Muscle repair can be done.
In cases where the muscle cannot be repaired, it can be considered to support it with a mesh by taking the implant prepectoral plane.

Kelly Schultz, MD · Answer

Based on your history and your symptoms, I would encourage you to be evaluated by a board-certified or board-eligible plastic surgeon sooner rather than later. Significant pain, breast asymmetry, implant movement, and changes in implant position all deserve a thorough examination.
The good news is that downsizing is absolutely possible, even after very large implants. The challenge is that after years with 670 cc implants, the skin and breast tissues have been significantly stretched. In someone your age who is otherwise healthy, I would strongly consider a staged approach. The first stage would be removing the implants, which allows your tissues to heal and your skin to retract for several months (aka an "implant holiday"). This allows your natural tissues to settle before deciding exactly what size implant (if any) and how much lifting is truly necessary.
Many patients are pleasantly surprised by how much their skin contracts during this healing period. By allowing that natural retraction to occur first, we can often minimize the amount of lifting required during the second stage, when a smaller implant and, if needed, a breast lift (mastopexy) are performed.
Whether you ultimately need a lift depends on your skin quality, nipple position, and how your breasts settle after implant removal. If a lift is recommended, most women are still able to breastfeed afterward, although no surgeon can guarantee future breastfeeding ability following any breast surgery.
As for implant size, choosing a size should be based on your breast width, tissue characteristics, and aesthetic goals (all of which can be assessed in a consultation) rather than a specific CC number alone. If your goal is a natural small C cup, that is often very achievable, but the exact implant volume varies from person to person.
I hope this helps and wish you the best moving forward!

Removal of large implants, lift, and exchange for smaller implants - Will I need a lift to fix the skin? (Photos)

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