The photos above show the patient before (left), and after replacement with a smaller gel implant (right). Note that while she is smaller after surgery, she also is less droopy. Normally, going down in size causes more, not less, droopiness, because larger implants fill out the skin more. Internal tightening with radiofrequency was needed on order to shrink her skin envelope. This minor to moderate lift can be done without adding additional scars.
A size change is not an infrequent request from my patients. The woman below wanted smaller implants. When she was younger, having larger breasts was important to her. As she aged, she noted that her implants made her look a little thick around the midsection; she wanted to look more slender. She opted to have her old implants removed and smaller implants placed.