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Choosing implant size for breast augmentation is not an exact science for patients.   In my office we encourage patients to take their time with this important decision and often recommend  a second fitting if patients are unsure of size.  Very infrequently would they rather be smaller after their breast enlargement surgery.  On occasion about 1 in 250 patients do choose to be smaller, but rarely choose to have their breast implants removed altogether (1 in 500).  Generally this is related to size interfering with physical activities and/or limiting clothing styles.  More patients express regretting that they didn’t choose bigger implants.

Just like increasing implant size, I recommend patients change their size by at least 100ml.  Otherwise it is hard to appreciate much of a change.  Reducing implant size can be easier than increasing size.  Usually the breast tissue and skin will shrink down to accommodate the reduced size.  Sometimes the natural scar tissue around the implant (periprosthetic space) needs to be reduced.  This requires internal suturing which takes longer to complete.  I do not suggest a breast lift with reducing implant size unless the nipple is below the crease beneath the breast.

Patients choosing to have their implants removed may seem like a simple surgery, but it is not.   It may be emotionally difficult to adjust to the previous breast size before breast enlargement surgery.  Some women find themselves depressed or feel down.  There can be significant emotional baggage associated with body image and self-esteem.  About half of the patients electing to have their breast implants removed, choose re-implantation in a period of time from 6 months to a couple of years after removal.  Body image is an important consideration for many.

The surgical aspects of implant removal are not as simple as it may seem.  Breast implants and the scar tissue around the implants (breast capsule or periprosthetic scar) interfere with mammograms.  If implants are below the muscle, they interfere a bit less.  Removal of an implant alone does leave scar tissue behind, which may lead to considerable interference with mammogram interpretation if left behind.  I recommend breast capsule removal at the same time of removal, in an effort to maintain reliable mammograms.

Just like the decision to have breast implants is a woman’s choice, reducing the implant size or implant removal is dictated by patient choice.  It is important that patients are fully informed prior to making this decision.


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