Currently have 650 cc saline implants with full 38 DD want to go down to an average D cup. (photo)

Thank you for the picture. Downsizing to about 450 or 500 cc implant should put you in that cup size range. I focus less On cup size versus your desired result. When speaking with your plastic surgeon I would bring pictures of your desired result and that can be more readily matched than a cup size.

Thank you for your pictures.  It appears that you have a bottoming-out deformity.  This is common after having large breast implants and after breast feeding.  You certainly will require a breast lift, but my biggest fear is that the bottom skin has stretched out to the point that it will not support even a smaller implant.  You may want to discuss with your board-certified plastic surgeon the possibility of using some sort of additional tissue support (Mesh, Strattice, Seri-Scaffold, etc) inside the breast pocket.  In my experience, this can assist with supporting the implant to prevent long term deformity and bottoming-out.  As far as the actual size goes, this is a difficult question.  I use "sizers" in the operating room to choose the perfect implant for your body frame and to accommodate the pocket.  You may want to discuss an acceptable range of sizes with your surgeon, so that they can decide the best option with you.  Above all, information is key....definitely worth discussing your personal situation with your surgeon.

At
size 38 each 200 cc’s of implant corresponds to 1 cup size change.450 cc implants would take you down to a 38
D.However, the greater problems you
have are the vertical scars from your previous lift and bottoming out of your
implants.This will require a
simultaneous lift.Unfortunately, the
vertical scar cannot be removed but can be revised by another circumvertical
lift at the time of implant exchange and you will need internal plication of the
capsule of the implant because they have bottomed out.Best Wishes,Gary Horndeski, M.D.

These can be challenging problems. In situations like this, we will usually deflate one of the patient's breasts the day before surgery under local anesthesia. We then use sizer implants and compare this side to the existing inflated breast. This is helpful in determining size. In terms of the lift, you should discuss options with your surgeon to try to maintain the results of this secondary lifting procedure. Ask if they think acellular dermal matrix is necessary internally to support the lift.

Dear sls,It is refreshing to hear that someone is actually downsizing their breasts in Texas.  The size implants that you have chosen to replace with should give you the desired D cup breast.  Also, the implants will be lighter and should age better than your current heavy saline implants.  Good luck!

Maybe but only in person detailed examination allows a more definitive response. Best of luck in your downsizing..