Will a 260-270cc round gel fit into the pocket from 370cc gel and look more natural? (Photos)

Most importantly, will it get rid of my upper pole fullness/side boob (which I hate) and give me a (desired) slope? Or would an anatomical, gummy bear fare better? Surgeon does not want to revise pocket due to a prior complication, 4 years ago. He wants to go through periaerola and leave my inframamary alone. Does upper pole skin sink naturally over new smaller implant? My desire is to look most like photos attached!

Doctor Answers 10

Change of breast implants to a smaller size from 370 mL?

Thank you for your question in the photograph.  I find it difficult to predict accurately how large a volume change can be accomplished without the need for capsulorrhaphy to prevent the implants from displacing to the sides.  My suggestion would be to allow the surgeon to choose the most appropriate round smooth silicone implant during the surgical procedure based on how your breast look.  I would guess that you could go down approximately 50 mL or perhaps slightly more but would not be confident that a 100 mL size change could be accomplished without wide cleavage and lateral displacement of the implants.

Best wishes and good luck.  I too prefer to use a periareolar incision unless the patient feels strongly that she wants the old inframammary scar reopened.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Will a 260-270cc round gel fit into the pocket from 370cc gel and look more natural?

Dear milla31

If you are downsizing your implants by about 25-30%, you are likely to need revision of the implant pocket. If you don't reduce the lateral space, you a likely to notice a step-off in the medial side( by your sternum) when you lay on your back. This determination can be made by your surgeon at the time of the procedure because it does not happen in every case but rather is an important consideration. If you already have an infra-mammary incision, it does not make good surgical sense to make a new areolar incision but I dont know your previous complication and its related issues. Best of luck with your surgery.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 55 reviews

Will a 260-270cc round gel fit into the pocket from 370cc gel and look more natural?

There is no way to be sure what the new look will be, but based on your statements it seems to me it would be worthwhile considering the anatomic shaped implants. But that will necessitate not only pocket modification but also a capsulectomy. Without an exam and without knowing your history of complications we can't make any solid recommendations. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Downsizing implants

Getting the right size and shape can be difficult during breast implant revision surgery. The capsule that forms around a breast implant needs to taken into consideration when planning an implant revision procedure. It is usually easiest to go bigger because only a small opening is required to make additional space for a larger implant. When downsizing, the capsule usually needs to be modified if the change is significant because this will prevent small implants form moving around in a large space . . . which can lead to an unnatural looking and wide cleavage region and implants that fall way to the side when lying down. Many times, surgeons will perform a capsulorrhaphy, which means the capsule will be modified. This can include simple electrocautery or "pop corning" of the capsule causing it to shirk in areas when it is gently burned with an electrical current cutting device called a bovie that is routinely used for everything in surgery. This can include stitches to narrow a certain area like the sides (to decrease the amount of "side-boob"). Sometimes the capsule is cut and folded on itself to make the results more dramatic. Sometimes a tissue matrix is added to bolster these repairs to make sure they are long lasting (products like Strattice or Galaflex and there are many others). Sometimes an entirely new pocket is formed . . . one that can be smaller and tighter on the sides to create a look that keeps the implants more central and pointing forward. This technique is called a "neo-pocket" or new pocket and requires making a new space in front of the old implant capsule, removing the old implant, and then suturing own the old space to collapse it. This ensures a new snug pocket for the new implant. This technique is the most reliable for downsizing implants. Many patients are also looking to create a more natural look when downsizing and changing to an anatomically shaped implant can help create this desired look. It is very important to make sure a new snug pocket is created when switching to an anatomically shaped implant to make sure there is no risk for rotation of the implants. Finally for patents who really want a natural look, fat transfer can be added to a breast revision procedure, and the fat can be carefully placed in areas to enhance natural contours - especially in the cleavage and the upper poles.

Kamakshi Zeidler, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 18 reviews

Will a 260-270cc round gel fit into the pocket from 370cc gel and look more natural?

From your photos and desires, I believe you are on the right track.  A reduction in volume of approximately 100 cc should be in the ballpark.  A tear drop shaped implant will give you less upper pole fullness, but this can also be achieved with a low to moderate profile round implant, as well.  If your surgeon would rather avoid adjusting the scar capsule, he/she will probably want to use an implant that is a little smaller in diameter than your present implant.  The upper pole should become less prominent with the smaller implant and should look natural.  Best wishes, Dr. Lepore.  

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Going smaller with smooth round implants

will help provide a less full upper pole and if you are fine with the lateral position when on your back, no real adjustments to your pocket are needed.  The textured gummy bears could be used but they will require a more generous approach and your surgeon obvious has a reason why not to use the IMF approach.

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

The right size for you

It is very difficult to determine the best implant you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Pocket revision likely needed when downsizing

Your goal pictures show less upper pole fullness so smaller implants will help, and round should work great. If you want less fullness on the sides, the implant needs to be of a smaller diameter and a pocket revision with capsulorrhaphy should be considered. 

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Less Fake Looking Breasts

There are several factors to consider including volume as you mentioned.  Going down in volume alone may not be the answer.  If this in done by itself, the "pocket" will likely need to be adjusted (capsulorrhaphy).  Otherwise, the smaller implant will move in the pocket and to the side.  This will be very apparent when lying on your back.  There are different Profiles of implants, each producing a different look.  As far as upper pole fullness is concerned "projection" and "diameter" is important.  The more projection and wider the diameter will produce more upper pole fullness "fake look".  The wider diameter of the implant will produce more "side boob".  The most important factor is choosing the right implant for desired outcome.  Using a "tear drop" gummy-bear implant is an option, this will decrease the upper pole fullness.  However, these implants are more firm, and are not designed to move.  If they do, the can become oriented in the wrong position. 
The most important thing is to have good communication with your surgeon, so both of you have a clear picture of the desired outcome.  The other, is choosing the right implant (projection, diameter, shape) to achieve your goal.

I hope this helps.  Good luck.

Ryan B. Tsujimura, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 14 reviews

Will a 260-270cc round gel fit into the pocket from 370cc gel and look more natural?

Thank you for the question. Based on your question, I think you may already have a very good understanding of what might be involved with downsizing of breast implants. Additionally, adjustment of the breast implant pockets (capsulorrhaphy) will likely be necessary to achieve the outcome you are looking for. 
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 “down a cup size” 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 to downsizing breast implants surgery concerns), helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 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.