Summary: Are you happy with the size of your breast implants? Did you like the size when you got them but now they feel too big? If you want to downsize or completely remove your breast implants, here are several considerations to make sure you are  well on your way to getting a good result.

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Prior to breast augmentation surgery, it can be very challenging for women to imagine what they’ll look like with implants, even with the help of visual aids like sizers worn in the bra temporarily. Larger breasts may also end up impractical for maintaining normal daily routines, especially for women who are very physically active. For these and other reasons, women may decide to downsize their implants, or have them removed entirely. However, explantation is not as straightforward a procedure as it may sound; the right surgical technique is essential for delivering optimum results, and the final outcome is dependent upon a number of different factors:

  • Implant SizeBreast implants necessarily stretch out the existing breast tissue and skin, and larger implants much more so than smaller. The amount of stretching that occurs is a determining factor in the final profile following downsizing.
  • Breast Tissue – Women who had a more generous amount of natural breast tissue before surgery are more likely to have a naturally pleasing breast size and shape after downsizing compared to women who had very small breasts prior to augmentation surgery. Texture makes a difference as well; firmer tissue retains shape better than softer tissue. Breast tissue distribution matters as well. The way the existing tissue adapted to the existing implant, and the way it redistributes around a smaller implant or after removal is key in determining final profile.
  • Skin Quality – The elasticity of the skin also affects breast appearance when downsizing implants. Younger patients with more resilient skin will find that the breast skin stays smooth rather than saggy, returning to pre-surgery appearance faster than older patients or those with a more lax skin quality.
  • Age – Chronological age is another factor to consider, primarily because of the related changes in skin elasticity and breast tissue. The length of time implants have been in place is also important; older women who have had implants for many years will see different results upon downsizing compared to younger women who had implants for a shorter length of time.
  • Lifestyle Factors – Changes that have occurred in the body since implantation, such as weight fluctuation, pregnancy, or breastfeeding, can all affect the way breasts will appear after getting smaller implants. Women who smoke or whose breasts receive more sun exposure will see differences in skin tone and breast tissue resilience compared to nonsmokers or those who avoid the sun.
  • Natural Breast Shape – If the breasts showed any degree of ptosis prior to augmentation surgery, or have become visibly ptotic since augmentation, the existing ptosis after downsizing may become more pronounced.

Surgical Considerations in Breast Surgery Revision

How, then, should these factors be weighed and compensated for during the surgery itself? First, a thorough evaluation of the patient is essential. Younger patients with a generous amount of natural breast tissue who chose smaller implants and have not had them in place for several years already are the best candidates for downsizing or explantation. Clearly, this is a small and specific segment of patients, so many other patients considering downsizing of implants will need a more detailed approach.

In patients who present with firm breast tissue and good skin elasticity, downsizing to a smaller implant may be performed quite simply without concerns over resultant ptosis. However, other women may require a combination breast reduction plus mastopexy for the best results. This can be performed simultaneously or in staged procedures, waiting until after downsizing to see if incorporating a lift is indeed necessary.