I Am Wanting to Have Large Implants Exchanged for Smaller Ones, What About the Risk of Loose Skin?

If your current size is 32 DD and you desire a C, that is 3 cup sizes smaller.  For a 32 inch chest that corresponds to 300 cc's.  Your 350 cc implants can be removed and excess skin resected through a circumareola approach.  Without the implants, your breasts will droop and you will need a mastopexy.  Depending on how ptotic it is, it is possible that it can all be done through the circumareola incision.  It is important that your remaining breast tissue is lifted on the chest wall and your nipples horizontally aligned to give you more youthful perky appearance.

Best of Luck,

Gary Horndeski, M.D.

Thanks for your question.  I dedicate a large portion of my aesthetic plastic surgery practice to revision breast surgery.  I think the "fear" in down-sizing implant cases is always that "I might need a lift".  A lift is always a possibility in down-sizing; however, it doesn't have to be done at the time of the removal and replacement.  It can be done in a staged fashion.  One thing I think that can be very helpful in patients with existing saline breast implant which it sounds like you may have from your description is a "pre-deflation" of the saline implants.  This is something I recommend when patients want to be smaller.  This involved "draining" the saline implants with a small needle in a simple office-based procedure which takes about 10-15 minutes.  We typically recommend doing this 4-6 weeks before the actual "removal and replacement" implant surgery.  This allows the "pocket" to shrink some before surgery and allow for a smaller (usually silicone gel breast implant) to be placed at the time of surgery, many times without a lift. Sometimes we have to supplement the breast implant with an ADM (acellular dermal matrix) such as Strattice or Galaflex.  This does not mean that you will not need a lift; however, it may give you "your best chance" of trying to avoid a lift and still get a smaller implant in a down-sizing scenario.  I think is an excellent option in patients that want to be smaller that have saline breast implants.  I hope this is helpful.  Good luck!

Considering you have a DD-cup breast size with a 350 mL overfilled implant you must have medium sized breasts baseline.  You have two very good options for obtaining your goal of a less droopy C-cup breast.Option 1: Deflate your current 350 mL overfilled saline implants in the office under local anesthesia then allow the skin to contract for 3-4 weeks (Simple procedure where using local anesthesia you poke a small needle hold in the implant and repeatedly draw out fluid until the implant is deflated).  Follow this with and implant replacement and tightening of the pocket (capsulorrhaphy) using implants in that are 100-150 mL smaller.  Since your skin is loose I would strongly consider changing to cohesive gel silicone implants (Allergan Natrelle Inspira Style SRF, SSF or SCF) which help decrease the chance of ripples.   With the contracted breast skin a breast lift can often be avoided.  If necessary, I reinforce the pocket with GalaForm Mesh.  This is an absorbable mesh which is replaced by tissue 3-5 times stronger and helps thicken the typical pocket.Option 2:  Remove the implants and replace them immediately with cohesive silicone gel implant in the same plane along with a periareolar mastopexy or vertical mastopexy to remove the loose skin.  This allows complete control of breast size and shape since the size and shape of the implant and skin envelope are all within the surgeons grasp.  In addition, Galaflex Mesh (absorbable reinforcement mesh) can be used to reinforce the breast lift.  While this approach gives the best shape overall and the most dramatic breast lift, it does result in additional scars which are usually thin lines which are not very noticeable.