What approach would you take in downsizing my implants? Wondering what type of lift (if any) I may need. (Photo)

I have had 425cc implants under the muscle for over 12 years. I'm pretty sure I have no natural breast tissue left after breast feeding. I had my saline implants swapped out 4 years ago for silicone. I still have some rippling which I would like addressed. Most importantly, I want to downsize a full cup size. Would I require a lift as well? I do feel like the skin and nipple and started shifting down but I don't feel the placement on my chest is sagging.

Doctor Answers 13

What approach I would take when downsizing?

The most challenging issue is how to accurately determine how much down sizing you will be happy with.  You would arbitrarily be asked to choose a certain volume down from your current size.  As for whether you will need a lift, you photos suggest that it won't be needed.  It does appear one breast is larger and attempts at improving your volumetric symmetry will also have to be considered.  In downsizing, you may be giving up some upper pole fullness so you should be aware of that as well.  And if rippling is your greatest concern, then you will want to go with the true gummy bear implants (shaped textured or the newest smooth round models)l  Finally, I would want to know your motivations for downsizing as your photos look pretty good as you are.

Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Smaller breast implants

Smaller breast implants in the 300cc range that are wider will help you feel smaller and possibly avoid undergoing a lift type procedure. The extra volume added in the Inspira breast implants may also help to decrease the rippling.  Next year, a textured version will be available and that may help with lateralization of your breast implants.
Best Wishes,
nana Mizuguchi

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 45 reviews

Revision Breast Surgery

Your arms are back and up in your photos you provided, making it difficult to assess breast ptosis. You will need an in person examination to determine the need for a breast lift. Having said that, looking at the photos and knowing your plans for down sizing, you would probably benefit from a lift. 
Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

You may need combo therapy.

I'm gaining a more experience in replacing implants with new shaped/gummy bear implants (and the new high strength cohesive + round implants from Sientra).  Because they ripple the least, they really seem to be the answer for patients like you.

Additionally, you might need combination therapy with some fat grafting of the really thin parts of your breast. That's a decision that most likely will have to be made in surgery and after the implants are exchanged.  It sure seems likely based on your photos.

Regarding your need for a mastopexy/breast lift, that cannot be decided without an examination, and might even need to occur during the surgery.  Once the decision has been made to reduce the implant volume, the magnitude of the volume change and the laxity of your tissues are the prime determinants of the type of lift you could need.  Again, if I had to guess, you'd probably end up with a circumareolar (around the nipple) type of breast lift.

Your situation demands an experienced breast surgeon who can make many of these judgments during the procedure.  A board certified plastic surgeon whose reputation you have some familiarity with will be your best bet.  If you'd feel better getting multiple opinions, I'd limit those to 3 surgeons.  You should have an excellent idea about the differences in surgeons after that many visits.

Revision breast surgery

Thank you for your photos and question.  It does not appear clear cut to me that you would need a full lift if you went down a cup size.  You will need internal pocket tightening for sure (capsulorraphy) but as far as a lift is concerned I would need to examine you in person to fully decide.  Make sure you see a Board Certified Plastic Surgeon who performs a lot of revision breast surgery before making your decision.  Best of luck to you!

Milind K. Ambe, MD
Orange County Plastic Surgeon
4.7 out of 5 stars 31 reviews

Breast implant revision

I appreciate your question.
My partners tv show "botched" is about getting the right advice about plastic surgery and trying to avoid problems.
I would recommend switching to an anatomic implant that may help with the rippling, but more importantly can give you the proper breast volume in a smaller size.
Internally we would need to close down the pockets. 
Once we got the implants sitting perfectly, we would then address the skin with a lift. This may be just around the areola or may need to be extended.
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr Schwartz

Changing to Smaller Breast Implants

Downsizing one full cup size will in my opinion require reduction of skin and closure of the pocket in the outer and lower regions.  If you wish more than a subtle change in implant size, then a full mastopexy should be performed since a periareolar or Benelli mastopexy done too aggressively to reduce skin will cause flattening and loss of breast and nipple projection.  As your implant gets smaller and lighter in weight, the severity of rippling should be reduced however thickening of your remaining breast tissue with fat grafts may provide further help if you have body fat available for transfer.
Some of my patients strongly wish to avoid incisions on their breasts (others don't particularly care or mind) and have the option of a Benelli lift but the decrease in size of the implant would need to be more conservative.  Discuss your choices and options carefully with your plastic surgeon and realize that there is probably no single right answer, just the one that sounds most appealing to you.

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

Site placement likely the key

From your description, it sounds like your current gel implants are still over the muscle. While its not common to have rippling within the implant with gel devices, you can have what we call "traction rippling" as the implant pulls against the skin and minimal breast tissue. Both of these issues would be addressed with replacement of your over the muscle implant with a new, smaller implant placed under the muscle. The new plane will put more tissue over the implant and minimize it pulling on the overlying tissues. Be sure that the procedure includes tacking the muscle down because once the plane is developed both under and over the muscle it can "window shade" without being tacked down. Good luck

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 31 reviews

What approach would you take in downsizing my implants? Wondering what type of lift (if any) I may need.

I think that a switch to gummy bear implants to improve rippling along with a lift would likely be a reasonable approach.

Kenneth Hughes, MD

Beverly Hills, CA

Breast Revision Surgery

Thanks for question and pictures. From the pictures your provided, I do not believe you will require a lift.  You nipple is in a good position. 
With your desire to downsize, you probably will need internal tightening of your capsule.  Also I would recommend to switch to a more form-stable silicone gel implant to try and minimize your chances of rippling.  Another option would be to add fat grafts to your breast to add some thickness to your skin if you have enough fat on your body to harvest.  That would really decrease your chance of recurrent rippling.
Get a consultation with a surgeon who's comfortable with revision surgery. Good luck.

Khashayar Mohebali, MD, FACS
Bay Area Plastic Surgeon
4.9 out of 5 stars 10 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.