One of the most common consults in breast surgery today isn't augmentation, it's downsizing. Dr. Sam Jejurikar (Dallas Plastic Surgery Institute) and Dr. Sal Pacella (San Diego / La Jolla) sit down for another candid, no-filter conversation, this time on why so many women who got bigger implants in their 20s and 30s come back 10, 20, even 30 years later wanting something smaller and more natural.

They cover:

  • Why cup sizes (C, D, double D) mean something different from every implant manufacturer, and why that confuses the consult from day one
  • The anatomy problem: what happens when a patient chooses an implant wider than her own breast base, and why that choice catches up with her later
  • "Internal bra" mesh support: what it actually does, what it doesn't, and where Sam and Sal disagree on how well it holds up over time
  • When downsizing requires a full breast lift versus a smaller scar option, and why patients often want to skip the lift they actually need
  • The ethical question both surgeons wrestle with after two-plus decades in practice: how much responsibility does a surgeon carry for an implant choice made years ago

Whether you're considering your first augmentation or thinking about going smaller after years with implants, this episode lays out the physics, the anatomy, and the honest tradeoffs nobody tells you about upfront.

Hosted by:
 Dr. Sam Jejurikar, MD, Dallas Plastic Surgery Institute
 https://dallasplasticsurgery.pro/

Dr. Sal Pacella, MD, MBA, San Diego, CA
 https://drpacella.com/

Beauty and the Beasts: two plastic surgeons, no filter.

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