Smaller Implants Revision, When Is The Best Time To Have A Revision?

28" ribcage,preops 32A now 32D.380cc Sientra round mod. they are too wide,I can feel the left implant under my armpit. Will they move to the front after healing? I am in 5weeks post ops. If I want to down size to 300,when is the best time to have revision? Do I need internal suture for smaller implants? Is it dangerous,how long will I completely feel normal? What risk do I take? I am sure I hate this size. I understand I still have swelling but they will not decreased much than now after all.

Doctor Answers 7

Revision with smaller implants

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At size 32 A each 100 cc’s of implants corresponds to 1 cup size change.  380 cc implants took you up 4 cup sizes to a D.  As you have stated they are too wide and they have displaced into your armpit.  This occurred because the weight of gravity pulled the implants inferiorly and laterally.  If your implants are sub-pectoral the implants would be extruded because they are only partially sub-muscular.  Unfortunately, without photographs it is hard to tell you exactly what to do.  However, there is a new technique called Implant Exchange with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to exchange the implants with smaller ones, reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  I always recommend silicone gel implants placed retro-pectoral since they look and feel more natural and are less likely to ripple.  Smaller implants placed totally sub-pectoral will less likely extrude and displace inferiorly and laterally.  You are only 5 weeks post-op, I would recommend waiting 3 months total time after the original operation.       


Best Wishes,


Gary Horndeski, M.D.


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Good afternoon!

You can downsize really at any time- but I recommend waiting another couple of months for things to settle and see if some of your dissatisfaction with size is due to a small amount of swelling or the fact that your implants may not have dropped yet. 

If you are feeling your implants up in your armpit and they are shifting up there when lying down, you may need some internal sutures to make your pocket a smaller size to accommodate a smaller implant.


I hope this helps

This complicated clinical situation does not have a short answer.

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Physiologically you can replace the implants any time. Your situation is complicated because of difficulties with the pocket as well as dissatisfaction with size. I think it would be a good idea to get a second opinion.

Neopocket and smaller implants

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Really need an examination to determine what will need to be done.  You are still very early in the post operative recovery period.  If your implants are too wide it is possible that you will need some capsule work.  I would not consider a revision for at least 3 more months.  At that time a neopocket type placement can be done so that the width of the new pocket can be controlled and adjusted to a smaller implant.  

Wait longer before considering revision

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5 weeks is much too early to decide. Even if you are 100% certain that want to be smaller, your multiple other concerns also need to be taken into consideration.

If they are too wide, your surgeon will need to determine exactly how wide the new implants should be.

Feeling the implant under your armpit after 5 weeks could be temporary muscle spasm or the actual implant which your surgeon will also need to determine prior to choosing a new implant and planning surgery.

The implants will not "move to the front", but the appearance of your cleavage will change and the skin will continue to stretch around the implants.

The best time to have a revision  is as long as possible. It takes at least 3 months for the implants to start to look normal and 6-12 months for the final result to be appreciated.

It is not dangerous, but all surgery carries risks. You will be taking on all the same risks you had before the first operation.

Your other questions are best answered by your surgeon. 


Armin Moshyedi, MD
Bethesda Plastic Surgeon

Smaller Implants Revision, When Is The Best Time To Have A Revision?

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Your questions are way too involved to answer in this format. You need to see someone who does this surgery, get an exam, and they will be able to answer. As to when to do a revision, most of us ask patients to give it at least 3 months.

Smaller Implants Revision, When Is The Best Time To Have A Revision?

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Sounds like your implants may be wider than your natural breasts, and that may be the problem. 

I don't really have adequate info for a specific suggestion (Photos, breast measurements), but if these are too lateral, that will not improve, and the usual reasons for delay are not as important. Any time is right, but carefully review with your surgeon your objectives, the problems and the solution.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.