Implant size change — going larger, smaller, or asymmetric.

Why women change implant size

Of all revision indications, size change requests fall into three categories that don't always overlap with regret:

1. The original size was wrong. Either too aggressive (often the surgeon's recommendation, not the patient's) or too conservative. The patient lived with it for some time before deciding to act.
2. Priorities have changed. Original implants placed in 20s for a fuller look; now in 40s, the same volume looks disproportionate or doesn't match a more conservative wardrobe.
3. Pregnancy and weight changes. Soft tissue volume changes around the implant. The implant size that was right at age 28 isn't right at age 38 after two pregnancies.

None of these are signs of a poor original surgery. They are normal evolutions in what someone wants from their body — and revision is the appropriate response.

Going smaller

The more common direction. Two technical considerations dominate:

• Skin envelope retraction. The skin was stretched by the larger implant. After downsizing, it may not retract fully, leaving some looseness. Younger skin retracts better; older skin and skin that's been stretched for many years retracts less reliably.
• Pocket dimensions. The pocket was made for the larger implant. After downsizing, the pocket may be too generous — leading to implant displacement. Capsulorrhaphy reduces pocket size to match the new implant.

The decision about whether to combine downsizing with a breast lift is the most important one. If the skin won't retract sufficiently, a lift addresses the looseness. Without a lift, you may have a smaller implant in a larger envelope — which looks empty.

Going larger

Less common as a pure revision; more often requested as part of a complete satisfaction increase. Technical considerations:

• Soft-tissue cover. The thickness of tissue between the implant and the skin determines visibility of edges and ripples. Going larger thins this cover.
• Pocket expansion. The pocket needs to expand to accommodate larger implants. The capsule is partially released, controlled enlargement is performed.
• Implant profile selection. Going larger doesn't have to mean going taller. A wider, lower-profile implant can add volume while maintaining a natural upper-pole slope.

Asymmetric size change

When breasts are uneven — either from pre-existing asymmetry or asymmetric primary surgery — different volume implants can be selected. Volume differences of up to 50 cc between sides are common and well-tolerated. Larger differences (>75 cc) are achievable but may require additional asymmetric pocket work.

Surgical technique

1. Original incision reopened. Inframammary fold or peri-areolar approach, depending on primary surgery.
2. Existing implant removed. Capsule inspected; partial capsulotomy performed if needed for new pocket dimensions.
3. Pocket modification. Larger if upsizing; capsulorrhaphy if downsizing.
4. New implant placed. Size confirmed with sizer first.
5. Closure. Original scar line.

Operative time: typically 90 minutes to 2.5 hours.

Recovery profile

Generally easier than primary augmentation:

• Day 1-3: Mild to moderate discomfort.
• Week 1: Surgical bra; light activity.
• Week 2-3: Most patients return to office work.
• Week 4-6: Light exercise.
• 6+ weeks: Full return to all activities.

Frequently asked