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Downsizing with Advancing Age

It is very common, in fact, weekly we seen women presenting to have their breasts downsized. In the earlier years, patients often will go with larger size implants, both saline or silicone gel, but as the 20-year-old advances into her late 30's or 40's, it is very common for these women to come back hoping to go with smaller implants and possibly the need for a breast lift currently. We see patients weekly who have had one or multiple breast augmentation surgeries. They have advanced in age, some in their early to mid 40's, some in their early 50's, who now simply desire to have smaller implants placed. The implants that were placed were normally moderate profile saline and/or silicone gel implants which appeared to be wide, matronly and large and as women age, it seems as though a significant number of them desire to go smaller. Using the high profile gels or the moderate plus silicone gels, we are able to reduce the size and width of the breast as well as maintain some shape. With advancing age, skin laxity can also become a problem in which patients, if they do decide to downsize, may require a breast lift at the same time. Reducing the volume of the implant itself certainly will allow for more space around the bag, which could increase further droopiness of the breast which may require a formal mastopexy using either a vertical breast, removing skin around the nipple areolar complex and vertically, or a formal mastopexy, removing skin circumferentially around the nipple area complex vertically and along the inframammary fold as in an anchor scar.

In general, women are accepting of the mastopexy scars, especially in the early to mid 50's, realizing that the only way to truly tighten up the brassiere skin when there is significant grade 3 ptosis, thereby the nipple greater than 3 cm below the inframammary fold, is by removing skin in both the vertical plane and the inframammary transverse plane as well as elevating the nipple areolar complex.

When women downsize their implants, my experience is that they have been extraordinarily happy over time and that they feel less heavy and less matronly on top and as if they have somewhat of a recreation of their body, feeling a little less disproportionate. Younger patients often desire a full C, small D breast. As patients age, we found that they definitely desire to go into the small C to mid C range. It is also not uncommon for these women to undergo further body sculpting procedures, including abdominoplasties as well as liposuctioning of the thighs and hips.

So therefore, with advancing age, in the majority of our patients we have seen that women desire a downsizing of their implants. Many are choosing to switch from saline to the silicone gel implants which certainly feel softer and more natural and have less visibility and palpability. Once again, if there is significant skin laxity, by reducing the volume, a concurrent breast lifting is certainly an option which should be considered.

 

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