Getting Smaller Implants. How Much Can I Shrink from 640/610 Ccs Without Getting a Lift? (photo)

I am 5'1 130lbs. 34 DDD. saline breast aug in 5/12 640ccs on the right breast. 610ccs on the left. Both implants bottomed out... bad. Nipples looking up bad. I had a bilateral capsulorrhaphy with the same surgeon in February 2013. Only 3 days after the surgery I noticed the right (640cc) implant moving. My right breast is now lower than the left. I am considering smaller implants and an internal bra. I'm concerned about loose skin but I'm trying to avoid the scars of a breast lift. Suggestions?

Doctor Answers 19

Getting Smaller Implants. How Much Can I Shrink from 640/610 Ccs Without Getting a Lift?

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Based on your photos, you definitely need to switch to smaller implants and and repair the inframammary folds.  Once the implants are in the correct position, your nipples should be more centered over the implants.  Hard to tell if a mastopexy is needed without an exam to feel the tissues.  Also need to determine how much smaller implants you want to go with.

Tampa Plastic Surgeon
4.4 out of 5 stars 40 reviews

Fixing "Bottoming Out" From Breast Implants

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Thank you for your question and your photographs.  Your petite frame cannot handle the large implants and you have had two procedures  that demonstrate that.  Your rib cage and soft tissues can accomodate only a MUCH smaller size.  There are several approaches.  Some plastic surgeons would tell you to remove the 640 and 610 implants and let your tissues heal before proceding.  You can then tell how well your skin will respond and make decisions from there.  I would guess that an implant half your current size is needed and you may need an ADM (internal bra) to secure the fold at the bottom.  A one step method is possible, but less likely t o be successful.  You do not need any more disappointments. Good luck!

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

What now?

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The capsulorraphy was the right operation, but unfortunately, it is difficult to get it to work with large implants. A vertical lift with smaller implants is probably your best option at this point.   Just make sure you find someone who is experienced in the procedure.  It is not as simple as it sounds.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 30 reviews

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Recurrent bottoming out problem with breast implants

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It makes perfect sense to consider smaller implants if you are having problems with bottoming out.  I am not sure about what is meant by an internal bra procedure without a  mastopexy or breast lift procedure.  More than likely you would need an inferior capsulopexy or possible support of the implant with Stratice.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Bottoming out

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Often with bottomng out it is best to use a smaller implant and repair the fold.  As for loose skin, I can not say because I have not seen you to make an assessment.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Getting Smaller Implants.

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To answer a question specifically about your condition we would need ht., wt., and front and side photos at the very least. If the lower skin, on exam, is excessively thin, Alloderm is a posssible answer. I rarely find the need for it when doing a capsule tightening to recreate a damaged fold. Burning the capsule with a cautery and oversewing it with an appropriate suture coupled with reducing the implant weight works over 90% of the time. It requires wearing a bra 24/7 for 8-10 weeks and avoiding any type of upper body exercise or heavy muscular activity during that time. I think you will need to reduce the implants by at least 200cc. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Getting Smaller Implants. How Much Can I Shrink from 640/610 cc Without Getting a Lift?

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     Smaller implants with a dermal matrix sling may be the best option to avoid further tissue thinning and bottoming out.   It is difficult to estimate the volume that could be reduced before a lift or a skin tightening procedure would be necessary.  Once you decide how much smaller you would like to go, an exam or pictures would be necessary to give valuable insight into the question of whether a lift will be necessary.  Kenneth Hughes, MD Los Angeles, CA

Best Breast Revisionary Operation for Me?

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I am sorry to hear about the complications you have experienced. Based on the limited photograph, I do not think that breast lifting will be necessary.  Capsulorraphy plus/minus the use of acellular dermal matrix will likely be helpful in achieving the results you are looking for.

 How much smaller the breast implants you will be able to use will depend on your physical examination characteristics, such as skin elasticity qualities.

 I would suggest that you select your plastic surgeon carefully based on demonstrable ability/success with revisionary breast surgery.  Then, communicate your goals carefully in regards to the breast size that you are hoping to achieve. In my practice, I find the use of goal pictures (not terms such as “natural” or "C or D cup")  helpful during this communication process.

 After this communication process, with the help of intraoperative temporary sizers  and careful measurements (dimensional planning),  the best breast implant size/profile to achieve patient's goals can be selected.

 You may find the attached link helpful to you as you learn more about revisionary breast surgery.

Best wishes.

Including a Lift with Smaller Implants

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It is certainly feasible to #downsize to smaller implants and also alter the positioning; if possible. However, decreasing is size may also require a Breast #Lift to to #tighten loose skin, better optimize the end result. Any #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome.#BreastAugmentation without a #BreastLift is usually a mistake looked back on by many patients. Most breasts will look larger and more droopy.They will sag more and sooner because of the excess weight altering the longevity of the results. The shape will usually not be satisfactory and sometimes results with “Snoopy” breast or double bubble. .A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is the most suitable for #breasts which sag or droop (ptosis) as a result of development, aging, pregnancy, breast-feeding and weight loss . Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy.
With both implant types there are choices when it comes to size, shape, and profile. The criteria best to suit you will be discussed in full detail at your breast augmentation consultation.  Altogether, the surgery will create an elevated, more youthful breast contour. Also, the nipple and areolae of the desired size and correct heightmay also be addressed. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

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

You MUST have a lift to reshape and reposition your breasts

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Your before photographs show you had asymmetry and ptotic breasts.  You would have benefited from a lift and implant initially.  You now have too large of implants that need to be removed, stretched skin envelope and distorted breast tissue.  You are an excellent candidate for a new technique called Implant Exchange with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to remove the implants, place new implants retro-pectoral of appropriate size, reshape your breast tissue creating upper pole fullness, elevate your breasts higher on the chest wall and more medial to increase cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall will give maximum anterior projection with a minimal size implant.  This technique avoids the ugly vertical scars of the lollipop or boat anchor shaped incisions.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 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.