Although the most common reason for revision after breast enhancement surgery is because the patient wants a larger sized implant, there are also many patients who find that they would like a smaller breast size. They may find that large implants cause back pain or look unnatural in relation to the rest of their body, their breasts may have increased in size due to weight gain or they may see unwanted drooping of their breasts with larger implants. Sometimes, large implants can also make certain physical activities or exercise uncomfortable. There are reduction procedures that can address each of these problems.

Why Not Just Take Out Some Saline?

Saline implants are designed to be filled after they are placed in the body. Some saline implants have a valve for adjusting fill volume after placement. However, this is intended for use during the initial breast implant procedure to adjust the size up or down slightly for the best look and for symmetry between the two sides. It isn’t intended for removing large amounts of saline to reduce the breast implants for a smaller breast size. An under-filled saline implant is prone to noticeable rippling and may fold and rupture.

Breast Reduction with Implant Replacement

This is the usual method for reducing breast size after implants. The existing saline or silicone implant is removed and a new, smaller one is inserted. The “pocket” may need to be adjusted or tightened to create a good fit for a smaller implant. However, since the pocket has already been created, the recovery period is usually less extensive than after the initial breast enhancement surgery. Women who are looking for a reduction to get more natural looking results often switch from saline to silicone when they have a revision surgery. They may also choose a sub-muscular placement of the implant to help ensure the edges of the implant are not readily visible.

Breast Reduction Without Implant Replacement

For women who have a substantial amount of natural breast tissue, a breast reduction may sometimes be performed while leaving the implant in place. This approach might be recommended to correct asymmetry if one breast has become substantially larger than the other or after significant weight gain. A reduction mammoplasty involves removing excess skin along with some fatty and/or glandular tissue to create a tighter envelope for the remaining breast tissue.

Incisions for this surgery may be around the areola, vertically down the underside of the breast or along the breast crease at the rib cage, depending on the amount of reduction needed. A minor reduction in breast size may also be achieved with liposuction. The results of a reduction without implant removal and replacement may be unpredictable. The surgeon must carefully evaluate the ratio of the patient’s own tissue compared to the implant size to ensure that the implant will still be well covered after a reduction.

Apparent Reduction with Breast Lift

In some cases, a mastopexy (breast lift) may be needed to correct ptosis (drooping) along with a reduction. When sagging makes sub-glandular implants appear too large or pendulous, a breast lift alone may help reposition the implants and make them look better. If skin laxity is a major issue, switching to sub-muscular implant placement may be the best solution for longer lasting results that don’t make the drooping problem worse. The incisions required for a breast lift are the same as a breast reduction.

Breast Reduction with Implant Removal

This is another option for patients who wish to return to a smaller breast size. Implant removal is fairly simple if there is no ingrowth of tissue into the implant (this tends to be more of a problem with implants that have a textured surface). The result is an immediate and significant reduction in breast size. However, the breasts do not naturally return to the same shape they were before breast enhancement. They may look smaller than they were or they may appear deflated and distorted. A lift, nipple and areola revision or other procedures may be needed to achieve an attractive result. Some patients may also choose autologous fat grafting (fat transfer using the patient’s own cells harvested via liposuction) to r