Daniel Crane, MD

The biggest pro is the immediate boost in confidence. You mentioned that you "really want to do this surgery". I imagine it is something you have been considering for a while and doing it now will likely give you what you are looking for in terms of volume. As for cons, your breasts will likely change with pregnancy and breastfeeding. I find that those who have more breast tissue to begin with are usually the ones who experience the biggest changes. As the breast tissue expands, the skin stretches. This often leaves the breasts deflated and in need of a lift. BUT this does not affect the implants. You may need an additional surgery to get your breasts to look the way you want after pregnancy, but this is also the case for many women who never had implants to begin with. Pregnancy won't affect the implants, but may affect the breast tissue in front of the implants.

You have already pointed out some of the main points. Saline implants feel less natural and are more prone to rippling. If you are thin, these issues are more likely because there is less tissue covering the implant. Very few of my patients choose saline implants today. Although it is subjective, most people would agree that silicone implants have a more natural look and feel. As you pointed out, if they rupture, you will not know without some form of imaging test. While US isn't as sensitive as MRI, it can pick up most ruptures (especially if you go to a radiology center familiar with breast implant imaging). Breast implant Illness (BII) is not recognized as a formal medical diagnosis (as stated on the FDA website). This constellation of symptoms can be found with both saline and silicone implants.

Modern implants are made with form stable silicone gel. If there is a tear in the shell of the implant, there are no major changes in the breasts and patients simply do not know there is a problem. The FDA recommends that an ultrasound or MRI is performed 5 years after implant placement and the repeated ever other year thereafter. If left alone, a ruptured implant often becomes a capsular contracture which requires more surgery to correct.

One of the major downsides to the subfascial approach is that there is very little tissue coverage over the implant. It is for this reason that I prefer the submuscular approach in most patients. You should be able to work out without any issues after a submuscular breast augmentation, I would only caution you to avoid exercises which specifically target your pectoralis muscle (chest muscle). If you are dead set on subfascial, fat grafting is an option to thicken up the overlying skin /breast tissue although it doesn't seem like you have a large supply of donor fat from your photo. The other option is Alloclae. It is an expensive, but effective product which is derived from human cadaver fat and can be very helpful for patients who do not have any donor fat. Hope this helps.

Silicone implants placed in women under 22 would be an off label use of the implants. Many surgeons do this. You will likely need to sign a waiver stating that you understand this is an off label use of the implants. The implant warranty will likely be voided as well.

Based on your photos, you appear to be an excellent candidate for a breast augmentation without redoing your lift. Your nipple appears to be in good position. You may have a slighty amount of ptotic tissue which could simply be removed through your previous IMF incision at the time of implant placement. This is much simpler than completely redoing your lift and depending on your skin quality and the size implant you choose it may not even be necessary. Hope this helps.

You are correct in that a mini abdominoplasty will not address the loose skin the upper abdomen. It should be mentioned that although the mini abdominoplasty has the word "mini" in it, it typically comes with a lower abdominal incision that is very similar to a full abdominoplasty. The benefit of the full abdominoplasty in your case would be that the upper abdominal skin can be tightened as well as your abdominal muscles. It is difficult to tell if you have rectus diastasis based on your photos. Do you have children? If so, you likely have some degree of separation of your rectus muscles and bringing them together will flatten your abdomen and enhance your waistline. Your other potential option is a reverse abdominoplasty where an incision is made beneath the breasts in order to tighten the abdominal skin above the belly button. Overall you appear to be in great shape. Unfortunately in order to tighten that skin, it will require an incision either beneath the breasts or in the lower abdomen.

The answer is it depends. It depends on how much skin laxity and fibrosis you have. Have you had children in the past or large fluctuations in weight? If so, you will likely need some type of skin excision to truly tighten the skin. Renuvion is helpful to get skin contraction when performing liposuction, but if you have visible skin excess you will be better served with a skin excision procedure. Hope that helps.

IMO, this would be unwise for several reasons. First and foremost, safety. A great deal of blood can be lost with pregnancy. Performing an abdominoplasty (which usually comes with liposuction) immediately after giving birth could pose serious risks to your health. Second is the cosmetic aspect. Pregnancy causes a great deal of swelling thoughout your body. If a tummy tuck is performed before this swelling is allowed to resolve, the surgeon will not be able to tighten your muscles and overlying skin to the same degree. Third. You will be dealing with a newborn. Trying to take care of a newborn right after a tummy tuck will be very difficult (breast feeding, waking up in the middle of the night, etc). You will want to bond with your child in the immediate days following childbirth, not be recovering from a tummy tuck. Although it may sound convenient, I would not recommend it. Wait and you will thank yourself later.

Simple implant explant is generally a simple procedure with a short recovery. I generally have patients wear a bra and tight wrap for the first several days in order to prevent fluid accumulation within the pocket. Most patients take little to know pain medication following a procedure like this and return to work after just a few days. I caution my patients to be careful with your arm movements and avoid strenuous activity for the first two weeks. The question of the lift is less straight forward. An in person exam will be necessary to determine how lax your skin is and how much breast tissue you have over your implant. I usually find that after an explant the breast tissue expands. The analogy I usually use is that of a compressed sponge. Once the compression is released, the sponge expands (much like the pressure that the implant puts on the breast tissue). A reasonable approach would be to remove the implant and give your breast tissue several months to expand. If you are not happy with the appearance or position of your breasts you could elect for a lift. Hope this helps.