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

2.5 years ago I had a sub-glandular augmentation (big mistake). 354cc (Right) and 378cc (Left) to correct a noticable size difference in my breasts. I am 28 yrs. old, 5’10 and 160 lbs. Before my procedure I was a full B/small C. Even though everyone says I carry the size well, I have had increased back pain these last 2 years (ouch!). I am so concerned about the scars of the lift, but I have this feeling that I will have to get some type of a lift. Feeling Heavy in Texas....

Doctor Answers 8

About Downsizing Breast Implant Size

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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.

Maximum projection with small implant using Mini Ultimate Breast Lift

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There is a new technique called Implant Exchange with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to replace your implants with smaller ones and place them retro-pectoral.  I recommend silicone gel since they look and feel more natural.  At the same time, your breast tissue can be reshaped to increase upper pole fullness, elevate the breast higher on the chest wall and more medial to increase cleavage.  Aligning the areola, breast tissue and implant high over the bony prominence of the chest maximizes projection and allows the use of a smaller size implant.

Best Wishes,

Gary Horndeski, M.D.

A Lift will be needed.

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The answers us yes.  When you downsize you will excess tissue that will need to be tailored over your implant (i.e. Lift).

Dr. ES

Possible Need for Lift

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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. 

Breast implant size

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If you down size, you may need to have a lift.  Best to be seen in person to be properly evaluated for the correct procedure for you.

Smaller Implant Exchange: Will I Need to Get a Lift As Well

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Given your issues it seems perfectly reasonable to proceed with replacement with smaller implants. I think your outcome will be best with smaller implants moved to the sub-pectoralis position and accompanied by a lift which would probably require an incision around the areolas (which would be made smaller and rounder) and a vertical incision down to the fold. 

Thanks for your question and for the posted photos. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Can I downsize my breast implants

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The choice of an implant at your first breast surgery is an important one but it is difficult to look into the future as you eluded to. Plastic surgeons will have different opinions but I am a big believer in the partially sub-muscular placement for better upper inner breast coverage and I think it provides better breast support as well. Given there is no replacement for an in-person exam, by your photos I would recommend the choice of a smaller implant placed in a partially under the muscle position with an appropriate breast lift. There are incisions and subsequent scars involved but in the hand of a plastic surgeon experienced in revision breast surgery, you should be able to achieve the results you are after.

Smaller Implant Exchange - Breast Revision

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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!

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.