Five years ago I had saline breast implants inserted. Since then, I have decided that they are too large for my small frame. What are my options at this point to reduce them? What are the risks and recovery time second time around?

Assuming that the only issue is the size of your breasts, I will describe the options available to you. Other complicating situations like scar capsules (excessively "firm" breasts), implant displacement, or sagging of breast tissues would require additional surgical procedures.

Your implants could be removed under a light anesthetic -- either conscious sedation, or a light general anesthetic -- and new implants placed which you feel are more proportional to your body frame. Currently, most plastic surgeons use saline-filled implants. They can be placed either behind the breast tissue, or beneath the pectoralis muscle. For my patients, I prefer submuscular placement (beneath the pectoralis muscle), because this placement may interfere less with mammography and provides a natural-looking result.

It can be quite an emotional roller coaster ride for a woman who, being self-conscious about her breast appearance, seeks out a surgical breast enhancement, chooses a surgeon, has a breast augmentation, and then ends up with a result that falls far short of her expectations - or even worse, results in a breast appearance about which she is even more self-conscious. I take this situation very seriously, and in my practice we do our very best to not only provide such patients with the enhanced breast appearance that they originally had in mind, but also to make the experience of consultation, surgery and recovery as positive and pleasant as possible.

Some breast augmentation revisions require a minor procedure several weeks in advance of the main surgery which is preformed in the operating room. One example is the deflation or removal of overly large implants. Large breast implants act as tissue expanders and stretch out the skin of the breast, which usually creates a droopy and unsatisfying appearance when the large implants are removed and replaced with natural-appearing implants of lesser volume in a single stage. If the excessively large implants are saline, they can be deflated in the office using a needle and sterile tubing. If they are gel implants and have not ruptured (which can be confirmed by means of an MRI scan), they can be removed under local anesthesia through the incisions by which they were inserted. Deflating or removing large implants gives the breast skin an opportunity to contract and shrink over several weeks, so that when implants of a more appropriate size are inserted the breast profile is perkier and more youthful. In many cases this minor office procedure can avoid the need for a breast lift (mastopexy) procedure. It also allows the internal implant space (capsule) to shrink, so that the new, lower-volume implants are not placed into capsular spaces that are too large - which would allow the implants too much mobility (often manifested by the implants appearing too far apart on the chest wall, and falling off the side of the chest when a patient lies down).