In 2004 at 43, I requested to go from AA/A to mod C. I had sub-musc 375cc saline o/f to 405cc implants. Ended up a DD and too big. I dislike how low they sit and the slight bottoming out. I went back to the original PS who denied there is an issue. The doctors on here recommended revision to silicone 300cc. I am concerned about excessive loose skin. Should I have the saline deflated (how far?) before revision or do anything else to minimize that possibility? Is this likely to be an issue for me?
Will Revision of Saline 400cc Down to Silicone 300cc Result in Excessive Loose Skin? (photo)
Doctor Answers 7
Revision "Going Smaller" in Breast Implant Exchange MAY result in Excess Skin
I agree with your concerns. It highlights the inaccuracy and fallacy of "going larger because you will regret not doing so" philosophy of breast augmentation. A more calculated choice of breast implants guided by your breast size and dimensions and helped by 3D digital imaging such as the Canfield VECTRA could have prevented this.
At this point I do think an in office deflation of the sale implant and observation will allow some breast skin shrinkage. You would o better with smaller implants but would require stitch repair making the implant pokers smaller and higher as well as a breast lift. The type of the breast lift would depend on the extent of skin shrinkage if any.
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Breast Augmentation Revision Options?
Thank you for the question and pictures.
I think your implants do sit too low on the chest wall and the skin of the lower poles of the breasts have been stretched significantly. Simply removing and replacing breast implants will not leave you with a nice results. You will likely continue to have implant malposition issues.
I would recommend that you have the breast implant pockets corrected ( made smaller) by using internal sutures (capsulorrhaphy) before re-augmenting the breast with smaller breast implants. I do not recommend directly excising skin ( and leaving external scars).
I do not think having the saline deflated is necessary.
I'm sorry if you become confused with all the different options available; do your due diligence and seek a surgeon who can demonstrate significant successful outcomes in similar situations.
Revision Saline 400cc to Silicone 300cc - Loose Skin
Your implants are definitely bottomed out and somewhat malpositioned. Your skin quality looks pretty good from your photo so it has the potential to contract somewhat over a smaller implant and you are not hugely downsizing. Doing a pre-deflation is a good way to get some skin retraction prior to replacing your implant. The amount of saline initially removed from you implant can very, but your implant will fully deflate in a fairly short time. When you have your new implant put in it should be done through an inframmary incision as the pocket will need to be repositioned and at the same time some skin from the inferior pole can be removed, thus further decreasing the potential loose skin issue. It is not evident that you need silicone implant, but it will feel softer.
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Breast revision post saline implants
Thank you for the photos. You answered your own question. I definitely would deflate your implants first. It takes 5 min in the office. I personally do not remove all the fluid out of the implant because it can cause some skin folding and irregularities. Normally I remove about 120cc and allow the implants to leak out over time. This will allow for skin tightening and most likely will avoid a lift during your re-augmentation with gel implants. You should be ready for your re-augmentation in 3-6 months. Good luck.
Downsizing Breast Implants
Downsizing your implants to 300 cc will lead to excess skin that is usually treated by having a breast lift. Office deflation is another good method to allow for some skin retraction. Then evaluation after several months can determine the appropriate size implant and potentially minimize the amount of lift needed.
Focus on your desired result
It seems you have an "OK" result but are not pleased. This means a little thought and discussion with your surgeon is in order before having more surgery., There are several operative choices. ...capsule modification, lift and implant size changes or a combination. Looking at where you want to be and communicating this with your surgeon will help him or her design your operation.
John Di Saia MD