Downsizing - Could I have a breast implant exchange without a lift? (Photos)

Question

I am currently 25 years old, I got a breast augmentation back in 2019 in Mexico. I am short and thin. I was completely flat and wanted to be a C cup. The surgeon decided to place Mentor round silicone implants, to address the size difference he used 300cc’s on my right breast and 400 cc’s on my left. I am a C cup however, my implants were in fact too big for my frame. I am now dissatisfied with the way they make me look as they don’t look proportional to my body at all. I am considering a revision to downsize the implants. I have had a consultation with the surgeon that did the augmentation initially and 2 other surgeons. The surgeon that did the augmentation said that it’s really easy for me to downsize and achieve a B cup which is what I am going for this time without a lift. He said that he could do this by using the same incision, closing the internal pocket from the bottom and sides with stitches that dissolve over time and placing new smaller implants about half the size of what I currently have. On the other hand, the other two surgeons I had consultations with suggested an areolar lift along with internal sutures to reduce the pocket size. These two surgeons refuse to use the same incision because they claim they would have to perform an anchor lift. I don’t understand why they want to remove skin if my skin is not saggy at all. I’ve never had children and I am naturally very thin. All 3 surgeons are certified but I don’t know which route to take. Help please.

Alan Gonzalez, MD, FACS · Answer

Hello  thank you for your question and for sharing so many details about your situation.

In my opinion, in your case it would be most advisable to consider a breast implant removal with immediate breast reconstruction, rather than simply reducing the size of your existing implants. Implant removal allows the silicone or saline implants to be taken out through an incision designed to minimize visible scarring; in my technique, I use an L-shaped incision, which provides safe and aesthetic access.

Instead of placing smaller implants immediately, I use the BRALAN technique (Breast Reconstruction Anatomical Lift Augmentation) to reposition the breast tissue and achieve projection, definition, and symmetry, maintaining a natural appearance that is proportionate to your body.

With over 25 years of experience, I understand what it feels like to be uncomfortable with implants and how important it is to achieve a result that looks balanced and harmonious with your figure. I am here to listen to you, explain your options, and help you achieve a safe, natural outcome.

Best wishes,
Alan Gonzalez MD, FACS
Member of the American Society of Plastic Surgery (ASPS)
Member of the International Federation for Adipose Therapeutics and Science (IFATS)
Member of the Colombian Society of Plastic Surgery (SCCP)

Jacob Carlson, MD · Answer

I understand both of the opinions that have been presented to you. If you decrease the size implant that you have, I absolutely agree that something will need to be done to reduce the size of the pocket/capsule. If it's a small change, then doing "popcorn capsulorrhaphy" may be sufficient. If it is a more significant change in volume, then something more aggressive like suture capsulorrhaphy will be needed. That plan will address the pocket/capsule that is immediately surrounding the implant.
Your breast tissue and skin has now been stretched out with 300cc and 400cc implant for six or seven years now. Since you are young, never had children, ?non-smoker?, your tissue will contract back down better than a lot of people, but to go from "completely flat" to a C cup is significant change, and your tissue is not going to retract back down to its pre-augmentation state after being stretched out for 6+ years. So, similar to what I had said above, if the size implant you change to is only a little smaller, then I think doing a popcorn or suture capsulorrhaphy through the inframammary incision is reasonable. If you decrease the size of the implant significantly (e.g. downsizing by 50%), then I think you're going to achieve a better aesthetic result with a more aggressive capsulorrhaphy and a lift of some kind. The periareolar option would allow the surgeon to address the mild skin laxity that has resulted from being stretched out and/or change the position of the nipple-areolar complexes.

Camille Cash, MD · Answer

From the photos it does appear you can opt for a smaller implant.  The first two photos indicate you may have bottomed out.  The pockets can be addressed during the implant exchange to correct this.  You can discuss with your surgeon the correct implant size(s) since you currently have two differently sized implants placed.

Downsizing - Could I have a breast implant exchange without a lift? (Photos)

Answers (3)

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