Can I Go Smaller In Size if I Replace My Breast Implants?
Q: Dr. Eppley, I have 350 cc breast implants placed over the muscle. I have had implants for 25 years, with replacement from silicone to saline fifteen years ago due to rupture. This time the left side has deflated. I was desiring either the option of total explantation or downsizing. I had a consultation with a breast implant specialist that stated he would not downsize me but wanted to go to 425cc and would not downsize due to the compromise in results. He will either increase the size or perform a total explant. I am personally not interested in increasing my size at age 50 whatsoever but am wanting to go towards my baseline look as much as possible because this will be the last time I have implants when they need to be replaced in the future. Is there a way a compromise can be reached for a slightly smaller look? I have read cases where many people have downsized. I realize 350 cc is not large. I could accept the same size if there is no compromise. I don’t expect perfection and I realize that the result would be less than perfect and I can live with that. What is difficult about the idea of total explantation is the bagginess.
A: I would agree that total explantation would be an aesthetically difficult choice due to the resultant loose skin and breast sagging, not to mention the volume loss. While it is always better from an aesthetic outcome (pickup of loose skin) to go bigger in a breast implant exchange in older patients due to the skin expansion of loose skin, if that is not what the patient wants then it is not better. What the plastic surgeon was saying about downsizing was that there will be more skin sag (ptosis) afterwards if one goes smaller. While this is intuitively true, the real question is how significant it would really be at, let’s say, a 300cc implant which is roughly a 15% volume difference. I suspect that it would not cause a significant sagging change. Therefore, I see no reason why you could not go to 300cc or 325cc with a new implant. And you have already stated that you can live with a less than perfect result.
Dr. Barry Eppley