Your aesthetic preferences at twenty-five may not be the same at thirty-five. Life changes — pregnancy, weight fluctuations, evolving personal style — can shift what feels right for your body. Many women who were happy with their implant size for years eventually want something different.
The concern is straightforward: will changing my implant size require a new scar on my breast?
For women whose original augmentation was performed through the armpit, the answer in most cases is no.
The Size Change Procedure
A size change is fundamentally an implant exchange. The existing implant is removed and a new implant of a different volume is placed in its position. Through the endoscopic transaxillary approach, this is performed through the original armpit scar — no new incisions on the breast.
The technical considerations differ depending on the direction of the change.
Going Larger
When increasing implant volume, the primary question is whether the existing pocket can accommodate the larger implant or whether the pocket needs to be expanded.
For moderate increases — going up one or two cup sizes — the existing pocket often has enough compliance to accommodate the new implant. The capsule that formed around the original implant has some flexibility, and the tissues have already adapted to housing an implant in this position.
For more significant increases, the pocket boundaries may need to be extended. With the endoscope, I can expand the pocket precisely in the directions needed — inferiorly, laterally, or medially — under direct visualization. This is important because over-dissection in any direction creates problems: too far down causes bottoming out, too far lateral prevents cleavage.
In my practice, I place implants up to 1445cc through the axillary approach. The incision accommodates large implants using Keller Funnel insertion technique, and the endoscope ensures the pocket is dimensioned correctly for the new implant.
Going Smaller
Downsizing is technically straightforward from an access standpoint — a smaller implant requires no more access than the current one. The consideration is pocket management.
A pocket created for a 450cc implant has excess volume when a 300cc implant is placed. Without modification, the smaller implant can shift within the oversized pocket, settling in an unintended position.
Endoscopic capsulorrhaphy addresses this by placing sutures inside the capsule to tighten the pocket around the smaller implant. I reduce the pocket dimensions to match the new implant, ensuring it sits centered and stable. The endoscope allows me to see exactly where the excess space is and where sutures need to be placed or if the pocket can be tightened with cautery.
Practical Limits
Very large size increases — for example, going from a 200cc implant to a 700cc implant — may present challenges. The tissue envelope needs time and possibly staged procedures to accommodate a dramatic change safely. In some cases, a direct approach through the breast may provide better control over the significant pocket modification required.
Similarly, very large downsizing — for example, dropping from 600cc to 200cc — may leave excess breast skin and tissue that a simple implant exchange cannot address. In these cases, a concurrent breast lift (mastopexy) may be necessary, which requires breast incisions by definition.
For the range of size changes most women request, the armpit approach works well.
What to Expect
A size change through the armpit is one of the most straightforward revision procedures. Recovery is typically faster than the original augmentation. Most patients return to normal activity within a week and full exercise within three to four weeks.
The new implant will go through the same settling process as your original — it may appear slightly high initially and drop into its final position over several weeks. This is normal and expected.
Planning a Size Change
If you are considering a size change and your original surgery was performed through the armpit, the first step is a consultation to assess your current anatomy, capsule condition, and the feasibility of your desired change through the existing incision. In most cases, the answer is straightforward: same scar, new size, no new marks on the breast.