Wanting a Smaller Implant Exchange: Will I Need to Get a Lift As Well? (photo)

First and foremost you should choose the size you desire.  Then do whatever is required to make the breast youthful, even and attractive.  A breast lift for you can be a home run in the hands of an experienced breast surgeon.  A mastopexy will reduce the size of your large areola, make them more even, and make the breast mound perkier and more even.  Most likely you are a candidate for a vertical or "lollipop" lift.  The periareolar scar will blend beautifully with your dark pigmentation and there will only be a short vertical scar. You will not need a scar along the fold, which is the scar that bothers women the most.  Make sure you pick an experienced surgeon in cosmetic and revisional breast surgery, ask to see pictures.  Hope this helps.  Good Luck!

From what I see in your photos I would recommend:

1. Implant exchange (saline to silicone)

2. Consider submuscular implant position

3. Periareolar mastopexy (this would reduce your areolar size)...I do not feel you would need a full lift and therefore could avoid a vertical scar on the lower breast

See a Board Certified Plastic Surgeon who is versed in breast surgery.