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Replacing Silicone Breast Implants with Moderate Sagging
As some of the other plastic surgeons have noted this can be a difficult problem. The issue is how large an implant would be required to correct the amount of sag you have. Plastic surgeons grade breast ptosis (sagging) by comparing the position of the nipple to your breast fold. If your nipple is completely below that fold with the implants you currently have then it is likely a larger implant will not be enough to get you a good result. Some plastic surgeons will stretch the limits of the correction an implant can accomplish by performing a peri-areolar mastopexy. Essentially this creates a purse string incision around your areola to decrease the amount of skin envelope. The problem with this technique is it typically is not very lasting and the scars - while limited to the areola - can be quite prominent and can widen. The best course of action for you should be discussed in depth with a board-certified plastic surgeon.
Clinical Context
Breast sagging (ptosis) is graded by where the nipple sits relative to the breast fold. When the nipple falls well below the fold, skin has stretched beyond what an implant alone can support, so increasing implant size usually won't fix the droop. A mastopexy (breast lift) removes excess skin to reposition the nipple and tighten the envelope, often combined with implant exchange. Discussing your specific ptosis grade with a board-certified plastic surgeon helps determine whether implant exchange, lift, or both will give a lasting result.
