Implants too large. Was 34B, 350 silicone. Now 34DD. HATE them. Do I need a lift? How much to downsize to be a large C? (Photo)

Question

Trying to sort out size of implant required to go down 1 1/2 sizes ? Will I need 250cc? 200cc ? to achieve a large C? Will I need a lift regardless of size of new implant? If a lift is needed, is there a minimally invasive approach WITHOUT the linear scar from the nipple down? can it be done effectively through the areola? What are the differences b/w the types of lifts? Is it better to be conservative and reduce less and if neccessary reduce additionally in the future?

Paul E. Chasan, MD, FACS · Answer

Your situation is not uncommon. I often see patients who need a lift, but are told that they just need a larger implant. The ultimate result is that they now have an implant much larger than they wanted AND breasts that droop even more. It is quite clear from your picture that you would need a lift, reposition of your implants or smaller implants to a higher location, and removal of redundant inferior breast tissue. This constellation of surgeries is what I term "Reductive Augmentation". The end result is a smaller, higher, more youthful breast. Of note, no one wants scars on their breasts, however when done properly, most lift scars heal very nicely. I wish you well on your quest.

Robert M. Lowen, MD · Answer

Depends on what your main concern is, the photos showing dependent breasts, somewhat large. A smaller implant in the  250 range looks like it might get you down to a D, but it looks also that your pre-existing size was larger than a B, based on the appearance with 350's. When the breast is large in comparison to the implant, peri-areola mastopexies don't work as well as when there is more implant than breast. The areola tends to get flattened.To answer this question better, a plastic surgeon would like to see photos of you before the augmentation, but it looks lie a vertical matopexy is needed, as well as a smaller implant. The amount of movement in the vertical direction looks excessive for a peri-areolar lift.  These questions really would require an in-person evaluation by your plastic surgeon to answer properly.

Ronald J. Edelson, MD · Answer

Thank you for the question.  I feel that a lift and downsizing of implants are both necessary to get a good result.  One of the reasons your breasts seem overly large is that they are ptotic, which is a nice way of saying saggy.  When the breasts are lifted to an appropriate level and smaller implants placed, I think you will be happy with the results.  Just going with smaller implants really doesn't solve the real underlyingproblem which is the ptosis.  You should consult with a few surgeons experienced in revision breast surgery and lifts in particular.  You problem is certainly correctable. That's the good news.

J. Jason Wendel, MD, FACS · Answer

Thank you for your
question.This might not be what you want to hear but you will likely need down sizing of your implants and a full breast lift with all three incisions.NippleVerticalHorizontalThe only way to get rid of the extra skin is to get rid of the skin.To be sure, see
two or more board-certified plastic surgeons in your area for a full and
complete evaluation to make sure you are a good candidate and that it is safe
for you to have surgery.

I hope this helps.

George Marosan, MD · Answer

Your breasts look large, pendulous and they are low lying on your chest wall. 350cc is about 11/2 cup size. You might do better with removal of the implants and a breast lift. Unfortunately, you are not a candidate for a periareolar lift, and do not let anyone talk you into one. If you hate your breasts now, wait until you'll see the periareolar lift result... I would recommend a vertical lift, which will control the shape of the breasts and areolae. BTW, I would suggest liposuction for your axillary fullness and lateral chest wall. One can also add fat to the breasts, after or during your breast lift procedure.See a board certified plastic surgeon experienced in breast surgery for an in person consultation/evaluation. Good luck.

Kenneth Hughes, MD · Answer

With the reduction in size, a lift would definitely improve the overall shape and position of the breasts.   I would seek several opinions from breast experts in your area.Kenneth Hughes, MDLos Angeles, CA

Larry S. Nichter, MD, MS, FACS · Answer

As you already have some significant sagging, this will only increase with a smaller implant. Therefore you definitely need a lift. I would recommend a lollipop (short scar) lift. Bring in a photo demonstrating what you would like to look like and your plastic surgeon can take if from there. Always pick a board certified plastic surgeon with expertise in breast revision surgery.

Thomas Fiala, MD, FACS, FRCSC · Answer

One option you should consider, since you want to go down by two cup sizes, is to take out your implants altogether, and do a really good breast lift.While this does mean having a vertical scar on the breast - it's really the most likely option that will give you a C cup size.  It also has the benefit of no future implant-related surgeries.Your current implants, 350 cc, probably account for about 2 cup sizes.  Going down to a 200 or 250 cc implant won't be enough of a volume change to give you the C cup you are requesting.All the best,

Curtis Wong, MD · Answer

Many options are available to you but you have to decide what is most important to you.  Once that is determined, the menu of options can be presented for your decision as to what would work best for you.  Lifts do require a vertical scar but there is a doctor in Texas that says otherwise... The vertical component helps with projection so I would be leery about the no vertical scar lift.  Best to see your surgeon or some other local surgeon to review your goals and find out your options.  If you don't like what is presented, then invest in a second opinion.

Michael C. Edwards, MD, FACS · Answer

There is no replacement for an in-person examination with a board-certified plastic surgeon. By the image you forwarded I would tell you that you would benefit from a full breast lift to achieve a smaller and perkier breast. A lift only around the areola without the vertical scar would most likely not give you a result your would be satisfied with.I hope this helpsDr. Edwards

Implants too large. Was 34B, 350 silicone. Now 34DD. HATE them. Do I need a lift? How much to downsize to be a large C? (Photo)

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