Ask Dr. Pane: I’m Downsizing My Breast Implants. What’s Involved?


The Question

Sometimes, patients have augmentation work done on the buttocks, breasts and other areas and aren’t entirely happy with the final outcomes. Perhaps the implants are too small or too large. Perhaps they shift, move or don’t sit quite the way the patient expected. Regardless of the reason, Atlantic Coast Aesthetics receives a great many questions about downsizing implants. One terrific example is the focus of this week’s Ask Dr. Pane segment. The viewer, who lives in the Miami area and contacted us through our Twitter page, asks, “I’m downsizing my breast implants from 425cc to 300 cc. I also have some skin rippling and the skin seems thin. What’s involved in this procedure?”

The Case

Dr. Pane perused the photos the patient included of her current bustline and breast area. He noted there is some rippling of the skin, but cannot properly evaluate the thinness of the skin based on the photos. This is something which can only be determined during an in-person clinical consultation, which is another reason patients need to keep in mind that photos are not substitutes for a face-to-face evaluation of the patient’s existing situation and desired outcomes.

The Answer


Whenever the question of amending or modifying existing cosmetic surgery work arises, Dr. Pane hesitates to quantify them as “easy” or “hard.” Every patient’s body is a little different. People heal differently, scar more readily or with more difficulty, take longer or shorter periods to recover or may be prone to conditions which interfere with what is typically expected for a “normal” recovery curve. Because of this, Dr. Pane prefers to refer to certain procedures as “straightforward” or “unusual,” because this more accurately reflects the nature of the procedure without attempting any value judgments as to the relative ease or difficulty the patient may experience.

In this case, Dr. Pane says reducing the implants should be a fairly straightforward procedure, although he is a bit skeptical about how the patient settled on the intended volume of the new implants. The existing implants appear to contain saline fluid, and have been placed over the pectoral muscles, rather than under them. This may contribute to the skin rippling the patient observed and also the perceived thinness of the skin.

For the best results, Dr. Pane said he would recommend swapping the larger existing implants for smaller new implants containing saline gel rather than liquid. These would be placed under the pectoral muscles instead of over them. The patient will almost certainly require some form of breast lift to offset any sagging caused by excess skin and other tissue remaining after the larger implants are removed, which is a very common side effect of having larger implants in place.

One crucial factor the patient will need to consider is the scarring which will be present after the replacement of the implants is complete. Since the patient has already had one augmentation, she will be familiar with how her body deals with healing and scarring, but as always, revising an existing procedure increases the risk of potential complications, including:

  • Accentuated scarring
  • Slower recovery and healing time
  • Increased likelihood of infection and other postoperative issues

Because of these issues, patients are reminded that adherence to any and all preoperative and postoperative directions issued by clinical or surgical staff is an important factor in preventing complications before they have a chance to get started. This includes taking all medications, such as antibiotics, painkillers and anti-inflammatories, in the prescribed manner; making sure to avoid habitual and environmental factors which may inhibit the healing process, such as drinking alcohol, smoking, exposure to direct sunlight and pollutants; and keeping up with postoperative appointments and maintaining contact with clinical staff in case something occurs which appears to be a problem or just “doesn’t look quite right.” It’s better to have false alarms than to overlook a real problem in the making, and will help ensure the best possible outcomes for their procedures.

RealSelf Patient Reviews of Thomas A. Pane, MD

If you have a question regarding any facet of cosmetic surgery, the staff of ACA is always happy to discuss your interest with you. Simply follow us on LinkedIn, Facebook, Instagram and Twitter; email us through our site’s Contact page; or call us at (561) 422-4116. Your question may even be selected as the focus of an upcoming Ask Dr. Pane segment, helping us get you the information you need and educate other patients who share your interests and concerns. Remember, at ACA we believe the only bad question is the one you don’t ask!


*Individual results may vary

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