Will I need a lift if I exchange for a smaller implant? Do my breasts look saggy and to large for my frame? (Photos)

I am 5'10 135 lbs, I went from a 32 B to a 32 DDD (375cc) which horrified me because I only wanted a D cup. I feel that everyone stares and they don't look natural and I'm always having to shift my nipples in my sports bra cause they point to far to the side. I want to go down to around 275 cc, I am 1 year post op. I hate the idea of scars on my breasts. Would I need a lift if I went smaller. Would it look better on my frame going a bit smaller?

Doctor Answers 9

Will I need a lift if I downsize my implants

Hi  and thank you for the question. I think in all likelihood a lift will be necessary if you decide to downsize. The lift allows us to reshape your breasts around the small implant. This is  The same principle that applies for a person who loses weight but wants to keep the same dress. You have to go to a tailor to reshape the dress to fit your new body. Most patients prefer to avoid the extra scars that are associated with the breast lift. However, in my experience,  patients almost always prefer breasts that have scars but a beautiful shape over breasts with fewer scars but a poor shape. My suggestion would be to discuss your concerns with your Plastic Surgeon. If you feel that he or she doesn't clearly understand your goals then my suggestion would be to get a second opinion. Good luck to you.

Dr West


Newport Beach Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast Implant Revision

Thanks for your pictures and question. The operation you decide on depends on what goals you are trying to achieve. A smaller implant will make you smaller in size, but you will loose fullness on top. Based on your pictures, I believe that a breast lift to remove extra skin, tightening the breast pocket internally to maintain shape, and a smaller implant would give you fullness and perkiness without being so large. Ultimately an in person exam with your plastic surgeon would be best to determine what options you have to attain the look you want.

Matthew A. Galumbeck, MD
Virginia Beach Plastic Surgeon
3.8 out of 5 stars 14 reviews

Dr Kayser

Thank you for your question. You clearly have a visible deformity which is understandably disconcerting to you. The large implants have significantly stretched the breast skin decreasing its ability to support itself resulting in both visible and palpable irregularities. The obvious drooping is apparent.

This is very correctable. Removal of the implants and exchange to a smaller size would add more excess skin which would necessarily require a breast lift. With current breast lift methods, you should do well with a short scar lollipop approach as the more traditional anchor or wise pattern technique would create excessive scarring and also compromise the naturally rounded shape of the breast. This would help to restore the breast to it's more natural position and also reduce the excess skin envelope. Internal reduction of the pocket and various methods to support the breast can also be undertaken. You would likely still be left with the thinner skin envelope which could be significantly improved with fat grafts. This is the ability of transferring fat from one part of the body to the breasts in order to add substance to the breast envelope and also increased volume to the cleavage and upper portion of the breast where an implant is unable to reach. This would also make it more likely to have better coverage should you desire to place the implants above the muscle which would allow elimination of any muscle animation deformity which is very common in patients who have had previous submuscular implants.

I would certainly encourage you to seek out consultations with board-certified plastic surgeons who are experienced in all types of breast surgery. Please feel free to view the mini videos on my website describing revision breast surgery and also that transfer Concepts. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.8 out of 5 stars 35 reviews

Smaller implants

I would have to see you in person to determine what might be necessary. A small circumareola lift may be procedure to do if the breasts appear to sag a bit. Hard to say without a good exam.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

Will I need a lift if I exchange for a smaller implant?

I am sorry to hear about your concerns after breast augmentation surgery. Yes, you should be able to undergo downsizing of breast implants. Keep in mind as you are thinking about your goals that sometimes adjustment of the breast implant pockets (capsule adjustments) may be necessary to achieve the outcome you are looking for.   Whether or not the adjustment of the breast implant capsules (capsulorraphy) and/or breast lifting will be necessary will mainly be dependent on your physical examination and how much you choose to downsize; specifically, factors such as the amount of redundant skin and quality of skin elasticity will be important.   If your breast implants were placed in the sub glandular position you may benefit from conversion to the sub muscular space.



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. 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 or D 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 revisionary, specifically downsizing, breast augmentation surgery concerns), helps. Best wishes.  

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,460 reviews

Do I need a lift if I go to smaller implants?

The decision to go with smaller implants often also requires a decision about a possible breast lift. Breast Augmentation enhances breast fullness and shape, but the placement of the implant in a space behind the breast gland (or both breast gland and chest muscles) can ultimately create a space that is too large for a smaller diameter implant. Commonly the space is made smaller (with internal sutures) to position the implant directly behind the contour of the breast gland again. But there is also the ligament support of the breast gland in front of the implant that may need to be adjust or tightened, which requires a lift. Repositioning the breast gland requires tightening the ligament support that is around the breast, likely leaving extra skin that is removed using incisions around the areola and on the front of the breast (possibly even in the crease along the bottom of the breast itself). While everyone wants to avoid additional incisions (including Plastic Surgeons) a breast lift may be necessary to create a "perky" and youthful shape. Please discuss these issues with your Plastic Surgeon, and possibly bring in photos of the look you desire. Your surgeon can then advise you of your options.

Douglas Leppink, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 26 reviews

Goals

I would not have expected for you to go from a B t o DDD with a 375cc breast implants based on your information.  If you are too large now, downsizing will help but you will need pocket work and possibly an inframammary fold resection.  Go and see your surgeon and express your concerns.

Best Wishes,

Nana Mizuguchi, MD

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 48 reviews

Breast Implant Revision, Toronto Plastic Surgeon, Dr. Adibfar

Hello 

Based on your photos and the history you have described, your implants haves stretched your skin and seem to be bottoming out.

You may benefit from the following:

1. Down size to a smaller tear drop shape implant placed in a dual plane position 

2. Tightening of the pocket capsule at the bottom and the sides of each pocket to support the new implants in their new higher and more medial position 

3. Possible mastopexy to remove any additional loose skin

A comprehensive consult and examination would be necessary to give you a more complete answer.

Please feel free to review our breast enhancement gallery on our website.

Thank you

Ali Adibfar, MD, DDS
Toronto Plastic Surgeon
4.8 out of 5 stars 75 reviews

Implant exchange

Without pre op photos, this is only conjecture, but I think the breasts are low on your chest. You may need a lift as well as implant exchange for a more pleasing appearance.  If your implants are above the muscle, consider going below for a more natural result.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 36 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.