31 August: Q&A with Ms Grainne Bourke

I had breast enlargement surgery eight years ago, which increased my bra size from an AA to a D cup. I would now like to have a breast reduction, by one to two cup sizes. I have read that this is a difficult procedure and one that is not likely to bring a good result. Would it be a matter of replacing the implants with a smaller size, or can fluid be removed from the implants to reduce their size. They are saline implants. Can you please advise?

Ms Grainne Bourke, Consultant Plastic Surgeon, Spire Leeds

In general, secondary surgery is always more complex than the primary surgery. This is definitely true in the case of reduction post breast augmentation. However, it is still usually possible to achieve a good aesthetic result. 

It is not possible to just remove some fluid from the implants unless they are tissue expanders (inflatable balloons). These are generally used for breast reconstruction.

If you want a significant reduction in size i.e. two cup sizes then you will probably need an adjustment of the breast pocket as well as the implant size. This is called a mastopexy or breast uplift. This procedure helps to reshape the breast and avoids the breast droop which would occur if you only have the volume of the implant changed.

However, if you are concerned about scarring then you could always have the size of the implants reduced and then, decide about a breast uplift at a later stage if you are unhappy with the resultant breast shape.

Silicone implants would help maintain a natural breast shape. They have a lower incidence of visible or palpable rippling (sometimes called implant creases) than saline implants.

The other thing to consider would be the location of the implants i.e. whether your implants are above or below the muscle.

It is important to discuss all the above with your surgeon and be sure that you are clear about what is achievable surgically for you.

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