Can you Reduce Implant Size After Breast Reconstruction?

[00:00:00]The out-sizing implants can sometimes be challenging. The We see patients commonly that are looking to downsize their implants and some of that has to do with uh shifting uh societal norms and some of that has to do with people aging and just wanting to look different. Uh and down-sizing implants can sometimes be challenging.

[00:00:19]The reason is that when a mastectomy is done, basically the breast is shelled out. So, a pocket is created and that pocket has to be filled out. It has to have an implant that's large enough to fill that pocket. When reducing an implant size, it's difficult because the easiest thing to do would be to excise some skin in one dimension and then pull down. But then you're really changing the shape of the breast. You're down-sizing the breast, but you're also losing a lot of that roundness and a lot of the projection. In order to really aesthetically reduce an implant following a reconstruction, you have to convert it to the anchor scar such as you do for a breast reduction. And when we do that, we're always worried about the blood supply at the T-point where the incision that goes up and down and the incision that go across meet.

[00:01:03]And if you have a small wound after a breast reduction, that's usually not a big deal. But if you have a wound over an implant, that can be a really big deal because the implant can get exposed and you can lose the implant. So, we're just hesitant to do it. In select patients who are really healthy, who do not need a significant downsize, and who have thicker skin over their mastectomy, we can consider it and we do it. We're always a little bit concerned and so, that's just one of the challenges.