The Surgeon Minute

Downsizing to Smaller Implants

Downsizing to Smaller Implants

Just as our tastes change as we get older, so, too, can our body aesthetic. Many women who got breast implants when they were in their early 20’s or 30’s often find that the size no longer fits their body, now that they are older. They complain about feeling heavy, even though they are in great shape, and feeling awkward in their clothes. These patients begin to wonder if they might be better off with smaller breasts.

Downsizing to a smaller breast size may be as simple as removing the implant, or exchanging your larger implant for a smaller one. However, in the patients who want to go from a very large implant to a much smaller one, some kind of soft tissue support and/or skin excision with a breast lift will probably be needed to deliver your ideal result. Board certified plastic surgeon Dr. Jason Cooper of Jupiter, FL details the various options for downsizing to a smaller sized implant.

Changing Body Aesthetics

Body aesthetics are a bit like fashion. Styles change; what looked or felt good when you were in your 20’s no longer works now that you are in your 40’s. Dr. Cooper certainly finds this to be true with his breast augmentation patients. Many times, a patient will come in for a consultation who had her implants originally placed about 15 years ago. The patient may be unhappy, and she tells him that she feels as if her implants are too big. They no longer match her body, lifestyle nor clothing. They make her feel heavy even though the patient is often in the best shape of her life.

The surgeon’s job in this scenario is to listen carefully to the patient’s desired ideal. In order to understand and create the proper treatment plan, a physical exam is performed to determine:

  • skin and tissue elasticity
  • if there is any ptosis, or droop in your breast
  • how much native breast tissue exists

Avoiding silent rupture with the IDEAL implant.


Removing Breast Implants Results in Smaller Breasts!

Once Dr. Cooper has a genuine feel for your anatomy and the state of your current implants, he can work with you to come up with a treatment plan that will suit your goals, body and lifestyle. For some patients, going smaller can be as simple as removing your current implants entirely. However, this only works for patients who have enough native breast tissue to provide the appropriate volume, and whose skin and tissue have not been stretched to the point where they will droop around the new, smaller implant.

“[These patients] need to be comfortable with the fact that their breast is going to deflate a little bit, and there are going to be some changes to their breast,” explains Dr. Cooper. The changes are usually related to deflation and a bit of de-projection, or flattening of the breast. The patient’s own understanding of the physical exam and options available to correct their unique situation is critical.

Downsizing Breast Implants

For those patients who want more volume than their native breast tissue will allow, Dr. Cooper will do an implant exchange, or downsizing the current implants to a smaller size. This will require some work on the capsule – the pocket that forms around the implant – in order to tighten it up, and make it smaller so that it will fit the new, smaller implant. This kind of straight exchange, without any breast lift or skin excision, only works on patients whose nipple and areola does not have much droop, and whose skin is tight enough to support the smaller implant.

Implant Exchange with a Breast Lift

“The most challenging patient,” explains Dr. Cooper, “is someone who comes in and says, ‘I had much bigger implants and I want to be much smaller now.’” In these cases, the capsule will definitely need to be tightened. Additionally, surgeons in this scenario may add a supporting structure called a dermal matrix. This acts almost like an internal hammock for the newer smaller implant, preventing it from slipping outward or laterally to the sides. “It’s really not just about the volume, but about the placement of the volume and keeping it up high on the chest.”

Breast ptosis in breast lift.

Also, in patients with larger implants, the skin has typically stretched and lost elasticity. In this instance, the surgeon will need to perform a breast lift in order to remove a significant amount of skin in order to make it “fit” the new, smaller size. Without a breast lift, the skin will simply sag around the smaller implant, and patients will not like the results.

Not Every Implant Exchange Requires a Breast Lift

The important thing to remember is that every patient is different. Some patients can remove their current implants and be done. Some can do a straight implant exchange without needing to remove any skin. Others, going from a very large to a very small implant, will need to remove some skin, but it may just be a bit from the lower or upper portion. Bottom line: “Not every patient needs a breast lift,” shares Cooper. However, if you do have significantly stretched skin, a breast lift, in addition to your smaller implant, is the only way to go.

“It’s really my job to guide patients through this process,” explains Cooper. A great breast surgeon listens carefully to the thoughts, desires, and goals of their patients, combining these with the results of a thorough examination of their current anatomy. These variables, combined with years of surgical experience, composite a tailored treatment plan that is right for the patient’s individual body.

Dr. Cooper shares that, “the patient satisfaction is incredibly high when going smaller.” Women feel more confident in their skin, ready to face a new period of life with a mature and wise aesthetic. From patient testimonial alone, downsizing to smaller breasts delivers a huge pay off. For plastic surgeons, this is much of the reason they chose the discipline: turning a patient with a problem into a happy, reinvigorated person.

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