I currently have implants and I want smaller breasts. What are my options?

This is a consult I see not too uncommonly. Typically, this patient had implants placed when they were much younger and had life changes – childbirth, breastfeeding, weight changes, etc. They now have larger breasts than they want. The different options are implant removal alone vs removal with a new implant vs removal with a lift vs exchange for a smaller implant with a lift vs removal with breast reduction vs replacement with reduction vs reduction alone. If figuring out what you want seems complicated it is. This can be broken down with some simple questions about goals. The first question to discuss is whether you would want a smaller implant replaced. This comes down to one main thing – remaining breast tissue after removal as well as desire for upper pole fullness. Upper pole fullness can only be achieved with an implant or with fat grafting. The need for a lift is simply determined by how much breast ptosis (or “droop”) a patient has. This is mainly determined by where the nipple and skin of the breast are in relation to the fold. If these are low, a patient often desires a lift to resolve this. As far as a reduction vs only a lift – this is dependent upon the remaining volume after implant removal. That most likely did not clear anything up. A thorough discussion about options in a consultation which would include anticipated results of each option is the best way to clear this up. The other way to very much simplify this decision making process which I have often employed is to remove the implants and see how the patient likes the size. With saline implants, they can simply be deflated with a needle in the office. This would leave the shell which would need to be removed later. With silicone implants, patients can often have the implants removed under local anesthesia only. This is typically a significantly reduced cost and downtime that allows the patient to at least with the volume of the remaining breast tissue and help determine the next steps.