Downsizing – Why It Doesn’t Always Make Things Simpler

For decades now, breast implant surgery trends were “bigger is better.” Many patients received very large implants, and wore them for years before making any changes or thinking about the long-term effects. But breast implants are not lifetime devices, and many women end up having to or choosing to remove them at some point. And when this happens, things can get complicated.

A large implant can do a few things. For one, it will stretch tissues- any and all that it can get a hold of. This can mean stretched skin and breast tissue, but it can also mean flattening of the ribs. This is especially true when the implant is under the muscle, as most are. The tight overlying muscle and the malleable cartilage of the midline ribcage can result in a flattening of the ribs under the implant itself. In some cases, this can even lead to a concave deformity almost like a bowl into the chest wall itself. In these instances, removing the implant does not just lead to a smaller breast size, it can actually mean a significantly deformed chest that almost requires some kind of reconstruction just to get back to baseline.

When it comes to the breast tissue itself, constant pressure can atrophy the breast, leading to a smaller amount of natural breast than the patient started with. In these cases, patients who decide to remove their implants may end up even smaller than how they started; and they often had no idea that this would be a possibility. The natural ligaments that run through the breast tissue and hold the entire structure up also get stretched, meaning that in most cases, the breast will actually sag more after the implant is removed, just from stretching out the support system.

In many cases, patients may choose to downsize rather than remove an implant completely. This is a strong new trend these days, with many patients recognizing that less is more, or finally changing something that was never what they had wanted in the first place. Depending on the amount of downsizing involved, it can be just as tricky to get the pocket to shape to its new implant as it is to recover a breast from the situation entirely.

While most patients who undergo breast augmentation report extremely high satisfaction rates with the procedure itself (over 85%), the removal/exchange process reveals a different statistic. In most cases, it is the patients who had the biggest implants who have the most challenging experiences making any changes. In many cases, they were not aware of what was involved in the long-term, and they are sobered to find themselves facing a bigger surgery or a lesser cosmetic result. It is important to recognize that the breast will accommodate small and large changes, but the bigger the change, the more it may become permanent. And while it may be hard to project that far down the road, it stands to reason that you have a better chance reclaiming something if you don’t push it quite that far.

Woman with one breast larger than the other.

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