Wise to downsize implants without pocket modification? Profile change?

Question

Hello! 8 months ago, I received 450 cc round smooth high profile Mentor implants. The result is a 28 G to H bra size and an unnatural look (in my opinion). I would like to have a more natural look, with a downward-sloping upper pole, and much smaller chest. Can I decrease to 300 cc without a pocket modification? Would a moderate /mod-plus profile fill the width of the pocket, while providing a less full upper pole? In your opinion, do my implants seem to wide for my chest? Thank you very much.

Farbod Esmailian, MD · Answer

Thank you for the photos.  Judging by the photos it appears that you are young and will likely do well with the skin retracting after down sizing.  I don't believe you will need any further procedures like lifts and so forth with a simple down size.  Looking at the implant diameters, going down from a HP of 450 to 300 Moderate plus, there is a significant diameter change.  I believe it would be significant enough that your surgeon may need to tighten the pocket/capsule.It is obviously best to be evaluated in person to discuss all your options more accurately.Good luck.

William Andrade, MD · Answer

Hello, your result looks excellent in my opinion, but your satisfaction with your body appearance is what matters.  Technically if you choose lower profile implants with a similar breast width, they could fit in the same pocket without it requiring any adjustment.  However, your surgeon would be the best source of advice whether your breasts would adjust to the smaller implants.

Jed H. Horowitz, MD, FACS · Answer

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.
The profile is determined by the amount of projection versus roundness that the you desire, as well as the size of the implant and size of your chest. As much as it's important to know what size bra you currently wear, the strap size is important to know as well. It affects the diameter of the cup and subsequently the diameter of the #breast implant that you choose. In my practice, about 15-20% of the patients are good candidates for silicone #shapedimplants.#Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle. This tends to more common in Europe and South America. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option, #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding. Your Plastic Surgeon will measure you to determine the best shape, size and placement of the #implants to be used. Lastly, another important element to a satisfying result of your #augmentation is realistic #expectations.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Sorry to hear you are not happy with the outcome. You have a nice result but if it is not what you were looking for, let me offer some options. If you are unhappy with the rounded upper pole, this is likely the result of choosing a round implant. If you want more of a sloped upper pole, then I think I wise choice would be an anatomically shaped implant. Your 450 cc implant has a width of around 12.8 cm with a projection of 5.1 cm. Mentor options for replacement:1) A medium height, moderate projection shaped implant: 355 cc, 13.0 cm W x 12.2 cm H x 4.6 cm P. This implant would be smaller in overall volume size but would preserve the width of your current implant, decrease the height, and also decrease the projection. 2) A medium height, moderate plus projection shaped implant: 420 cc, 13.0 cm W x 12.2 cm H x 5.5 cm P. This is essentially the same implant as #1, but provides some additional projection and more overall volume. The projection on this implant would be more than your current implant but the point of projection would be lower on the breast due to the anatomical shape of the implant.As you can see, this process to achieve your goals can be complicated and requires a lengthy discussion. Shaped implants come in all versions of height, width, projection and can be somewhat confusing, but might be the perfect answer for someone like you who is trying to get away from the typical "augmented" look. I think as long as you keep the width of the implant similar, you will require very little in the way of pocket modification.  Best of luck!

Brent Moelleken, MD · Answer

I am a strong believer in using internal pockets when downsizing implants.  It is more work, but you don't want to have the skin bear the brunt of the weight of the implant.  There are other find points of the surgery that are also important- anticipated nipple position, IMF position etc. that will require experience and judgment.

Curtis Wong, MD · Answer

really examine your motivations to change what is really a good outcome.  If you truly must downsize, you can and it should help with achieving a less convex upper pole but now you're having to accept all the risks of surgery again, including the risk for the dreaded capsular contracture.  As for width, they look fine but if you're not wanting any side boob, taking that part down will make your nipples rotate more lateral and give you the 'fish eye nipples'.  So make sure you really have to have this done before choosing to have more surgery.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. Yes, you should be able to undergo downsizing of breast implants (without the need for processing).  Unfortunately, it is very difficult to tell online whether or not adjustment of the breast implant capsules will be necessary when you downsize.  Whether or not adjustment of the breast implant capsules will be necessary will mainly be dependent on your physical examination; specifically, factors such as the amount of redundant skin, quality of skin elasticity,  and how much you downsize will be important.  
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 breast surgery, specifically downsizing breast augmentation surgery concerns), helps. Best wishes.

Rick Rosen, MD · Answer

Thank you for your questions. An examination would be necessary to totally answer your questions. But in my opinion HP implants give a more unnatural shape with a high takeoff. From the front view they can look good as yours do.The most important thing in deciding which implant to use is the base diameter of the breast. Your implants are well positioned medially by the breast bone (sternum), but do project laterally under the armpit due to the size of the implant used. A high profile implant is used in someone with a narrow diameter that wants a fuller sized breast. A moderate plus implant is a more natural choice in my opinion and what I use in almost all cases. But the size to use depends on the base diameter of the breast. To drop 150 cc's or a full cup size, I believe that your breasts would droop and you would probably need an uplift to be pleased with the result. I would recommend you discuss this with your surgeon. Good luck.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photos but an examination is really needed.  That said when downsizing a pocket revision is frequently neededDr Corbin

Ronald V. DeMars, MD (Retired) · Answer

If your implants are under the muscle and the new implants have the same diameter as the current ones you might be able to get away without any change in the pocket size. I agree with your aesthetic evaluation, the smaller volume will have a nicer look for your torso.

Wise to downsize implants without pocket modification? Profile change?

Answers (10)

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