What would I need to have done for Breast Implant Reduction/Revision and possibly a lift? (Photo)

Existing Implants Mentor Saline Smooth Round Moderate Profile 350, 10/20/2010 L: 400 R: 375 (unsure) I have lost a significant of weight since the procedure and they are now rippling and one is lower than the other. They sit too laterally from each other as well and they are too big for my body. Current Size: DD, would like to be a C. What are my options to get the breasts I want? Please see photos. Ready to schedule with right Dr.

Doctor Answers 13

Saline implants have drifted "down and out"

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Thanks for the photos, which illustrate a common problem for women with smooth saline implants, namely they #drift "down and out", widening the cleavage and contributing to the problem of #"side boob".  The chest wall's bony slope is one of the principal reasons for this.  No one's rib cage is a flat table, but rather more barrel shaped.  The weight of the smooth implants, the absence of significant capsule and your weight loss also contribute to your predicament.  On profile, your nipples appear to be at the same level as the fold, so I am not sure that you would need a lift, unless your implants are on top of the muscle. My approach: 1.smaller implants under the muscle; 2. consider textured high profile cohesive gel implants; 3. recreate the normal anatomical borders with ADMs (internal bra); 4. review many pics and interview thoroughly, until you find the right fit.  Good luck.  

Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Implant Reduction/Revision and Possible Lift?

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The changes that you are seeing are not unusual for smooth surface saline implants. The problems of implant malposition and rippling are more common with larger implants but can be seen with smaller size implants particularly in smaller women with thinner tissues. 

When downsizing there are a number issues that need to be considered. First will be what type and size of implant to change to. Typically one will need to go down at least 50cc or more to obtain an noticeable size reduction. If you have a problem with visible rippling you should consider switching to a silicone gel implant which will be less prone to this problem, although not guaranteed to eliminate all rippling if your tissues are really thin. A gel implant will also provide the additional benefit of feeling and looking more natural.

To correct the problem of implant malposition something will need to be done to reposition the internal implant pocket. Typically this would involve doing internal suture tightening of the pocket which is called a capsulorraphy. This will reduce the size of the pocket as well as address the malposition problem. Sometimes additional shrinkage of the implant pocket will be necessary using a procedure called "popcorn technique". Also placing the implant under the muscle (if it isn't already under) will help provide a more natural look and will minimize the risks of upper pole rippling.

Finally it may be necessary to also shrink the external skin and tissue envelope so that it matches a smaller size implant. Reducing the external tissues will usually require some type of breast lift which means additional scars on the surface of your breast. No one is excited about having scars on their breast, but the results will not look good if you have excess skin sagging on your new repositioned implant. It is not possible to tell without seeing you in person, but your skin quality looks pretty good. Sometimes, if the downsizing is not too great, and your skin quality is good enough, it may shrink on it's own to conform to the new implant. Another technique that could be employed would be to drain your implants using a needle and then wait several months before replacing with a new implant. By taking the pressure off of your skin this will hopefully allow it to shrink down on it's own and allow you to downsize your implant without doing a lift. 

Breast implants revision

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Thanks for your terrific presentation. By looking at a one dimensional photo of your current canvas, I would suggest several things.
1) exchanging the saline to a silicone to achieve a more natural look with less rippling and wrinkling.
2) I would also suggest placing the implants below the muscle if they are not already to have a more improved upper slope. This provides a more natural appearance
3) performing what's called an internal capsulloraphy, or an internal, suture pocket revision to make your pocket smaller in order to accommodate the smaller implants. This prevents migration of the implants which are already occurring to you.
4) performing a lift is a serious issue and I do not place scars on the breast in a cavalier fashion. I believe they should be thoroughly discussed and the decision made with the patient before going into surgery of whether lift scars should be undertaken. It appears that your nipple is above your bottom breast fold, however, that will also need to be raised up with the internal pocket revision in orderto accommodate the diameter of the smaller implants. If the nipple is above the new, breast fold; which we can simulate in clinic, then you will not require a lift. I consider scars on the breast serious; and, should be only done if it is the only and last option. Finally, all these serious issues need to be discussed with an experienced plastic surgeon in a candid fashion where you know all the options available. Good luck on your journey!

Sean T. Lille, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 32 reviews

What would I need to have done for Breast Implant Reduction/Revision and possibly a lift?

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Your existing breast implants have become malpositioned. In order to improve the shape of your breasts and position of the new implants, your pockets will have to be repaired. This can be accomplished in various ways. To improve the rippling, exchanging your saline implants to silicone can help. It would be best to discuss your breast augmentation revision options with your local plastic surgeons. Thank you for sharing your photos and concerns. Best wishes.

Dr. Gregory Park

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 177 reviews


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Thank you for the question and photos.  One of the main issues that is impacting your breast shape is the size and location of the breast implant pocket. Therefore, the main component of optimizing your breast shape and appearance as well as preparing it for a smaller implant is a capsulloraphy which is suture repair of the breast implant capsule.  This will have to be done on the side of the chest, at the breast fold and near the middle of the chest.  A breast lift may or may not be needed at that point but your plastic surgeon can make that decision in the operating room.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

What would I need to have done for Breast Implant Reduction/Revision and possibly a lift?

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 Congratulations on your significant weight loss. Based on your question, I think you may already have a very good understanding of what might be involved with downsizing of breast implants.   Because of the breast implant displacement concerns, adjustment of the breast implant pockets (capsulorrhaphy) will likely be necessary to achieve the outcome you are looking for.  This procedure would certainly help improve your breast symmetry and better position the breast implants on your chest wall while standing and in the supine position.

 Depending on your physical examination and goals, additional "maneuvers" such as breast lifting may be necessary.  In general, the smaller patients wish to go with downsizing breast implant surgery, the more likely the breast lifting will be necessary.

Generally speaking, the best online advice I can give to ladies who are considering revisionary (downsizing) breast augmentation surgery is:

1. Concentrate on choosing your plastic surgeon carefully. I think that this will be the most important decision you make. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.

I hope this, and the attached link (dedicated specifically to downsizing breast implants surgery concerns), helps. Best wishes.

Lift, Replace Implants or Both

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The intentional result of a Breast Lift (#Mastopexy) is to improve the shape and position of the breast without reducing their size. It is used especially for breasts which sag or droop (#ptosis) as a result of aging, weight loss, pregnancy, or breastfeeding. However, many women report more satisfaction if an implant is used at the time of #mastopexy. The implants further shape their breasts, restoring superior fullness or volume which may be decreased over time.
In regards to implants alone, this is usually said to be mistake by patients reflecting back at the decision. Most breasts will look larger and more droopy with solely implants. They will sag more and sooner, due to the sudden and excess weight. At times it's possible for a “Snoopy” breast or double bubble to develop as a result. There are a variety of techniques for a #BreastLift. I prefer to use the short scar technique, “#lollipop scar” or “#donut lift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring. Although the “anchor-shape” or inverted “T” incision is still more popular in the United States, it represents an older technique with extensive #scarring and a less optimal result in many cases.
It is imperative you select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast augmentation. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Breast Implant Exchange and Possible Mastopexy in Melbourne, Florida

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If you feel that your current size is too large, I would recommend you have a complete consultation with a board-certified plastic surgeon and visually look at various implant options in the office including something slightly smaller. Generally speaking you may have to go around 100 cc smaller to see about a cup size difference in someone of your frame size. If the implants were not originally placed beneath the muscle, that would be an option if you decide to replace them. As placing them behind the muscle will offer the added advantage of the “internal bra” that the muscle itself can provide. If they were originally placed under the muscle, they may have slipped from beneath it inferiorly and laterally simply as a result of tissue laxity and the weight of the implant stretching the tissues over time, which is a common occurrence. Closing up the capsule with some internal suturing can assist with this as well. In addition, you may want to consider a mastopexy, which is a breast lift, for the optimum result. Hope this helps. Best of luck to you!

Amy Ortega, MD
Melbourne Plastic Surgeon
5.0 out of 5 stars 42 reviews

Breast implant Revision or Reduction and Repositioning

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There a number of breast profiles we see that include breasts sitting way laterally on the chest naturally. chest. I suspect your preoperative photos do show a wide breast axis  such that the nipple positions are out to the side.  The doctor must have attempted to position the breast implants so the nipples were aesthetically centered---- just lateral to the ideal vertical line, and just below the ideal transverse line. The nipples should be 21 cm or so from the notch between the collar bone and about 21 cm from each other. I believe your current implants are sitting where the tissues are located.   To enhance and correct this result, the right nipple needs to be placed at 20-21 cm and lifted.  I would tape splint your breasts in the position you seek. That seems to include closing off the outside pockets and opening more room closed to the cleavage zone. The taping will dictate both pocket modifications moving things medially, as well as size considerations.  If the taping makes the breasts look great as they are, then I would consider just doing the pocket expansion toward the center, and dropping breast volume down to the 300 cc range.  Remember, adjusting the pockets to the middle will make the breasts appear fuller as well.  This is a challenging revision but must be planned with breast taping, so you can get a true visual of the new breast position that is expected, or for that matter what may be limited by your natural anatomy. I like smooth implants because they are easy to work with, stay in place for me, and offset any rippling that one can see with textured implants in very slender women regardless of under muscle positioning.I

Donn Hickman, MD
Los Angeles Plastic Surgeon

Find a surgeon you trust and who has a decent revision policy

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as your fix will require adjustments of your pocket, a lift, and downsizing implants.  The biggest challenge is just how much is the right amount to downsize???  All surgeons will tell you they can do this.  But its possible you will need revisions if things don't hold as hoped for so find a surgeon with a revision policy you can live with in case you need it down the road.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 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.