4 Years Post Op, Exchanging For Larger Implants. Will They Meet My Expectations? (photo)

Height 5'4 130 lb and had a breast aug. 4 yrs ago. Just last week I have noticed a deflation and went back to my surgeon. I am having both redone due to wanting to go fuller. I was an A cup before first surgery and now a C cup(370 cc) using a saline. I want a full D and he suggested a 500cc to 540cc hp. saline Im looking for a fuller breast with less sagging. When I come out of surgery I want to see a big difference in my breast size and concerned that it wouldn't be enough. Got any advise?

Doctor Answers 13

Breast Implant Revision?

Thank you for the question and pictures.

It is impossible to say whether the 502 to 540 mL implants will meet your goals.

Prior to proceeding with the revisionary breast augmentation surgery it will be very important to communicate your size goals with your surgeon.  In my practice I find the use of goal pictures to be very helpful.    I have found that the use of words such as “natural” or “D cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.  

 Best wishes.

Bigger---Yes. Less Sagging---No.

Dear Jacquieg,  With the increase in size you are considering, you will be larger in size; that is a given.  Unfortunately because of your body build and your breast tissue's characteristics, with the larger implant and its increased weight, you probably will sag even more than now.  This will not be immediately apparent after your surgery but as the tissues stretch under the increased weight, the breasts will again sag.

Have you considered a silicone implant instead of a saline filled device?  While silicone implants will not halt the problem of sagging, they may be less likely to ripple and wrinkle than saline implants.

Hope this helps.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.5 out of 5 stars 63 reviews

Caution going to larger implants

In general, larger implants mean bigger problems in the long run, including such things as bottoming out, visible ripples, and malposition. This is more likely when there is poor tissue coverage as in thin patients such as yourself. Consider silicone implants for less rippling, and you may benefit from an acellular dermal matrix graft such as Strattice for an internal bra.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 42 reviews

Re-augmentation/replacement of breast implants

I would disagree with a number of issues mentioned in the answers here and stress a few things not mentioned directly. Breast implants do not lift breasts and larger implants do not lift them more. Your breasts are off-axis (point off to the side), wide apart, and look completely filled by the width of the existing implants. I don't think a larger implant will fit well and will not look at all natural, particularly if it is a high profile (off-axis, widely spaced, somewhat ptotic breasts do not look good with a lot of forward projection). 

I don't think (although I can't prove it) that implants cause breasts to sag, larger implants cause breasts to sag more or faster, and silicone-gel filled implants cause less sagging than saline-filled. If you already have properly filled saline-filled implants, a larger saline-filled implant that is also properly filled will not ripple more or have additional problems the first didn't. Breast implants are like a pillow rather than a weight and if your breast is going to lose tissue tone and sag it is going to do it regardless of the size/weight/type of implant. 

In many cases for a replacement procedure (starting with middle profile implants), the width and forward projection of the implant can be increased by about a half cup size each but in your case I wouldn't advise it as I think you will look rather unnatural. I do think you can stay with saline if you're doing okay with the feel but I wouldn't increase the forward profile and I wouldn't increase the width of the implant more than a cm or so because of the characteristics of your breast. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

This may not be the right thing to do

Here is why I think this plan is not what I would do:

1. You have thin skin and not a lot of breast tissue to cover the implant.  Switching to silicone will avoid the potential that such a large size slaine implant will wrinkle right through your skin

2.  You have a thin frame.  Going to 550 cc's from what you have now will give you larger breasts but they may very possibly look like fake breasts.  If that's what you wan then go get it.  But you have a natural result now and you may possibly be losing that with larger implants

3.  Just so you know my opinion on this:  Your implants are pretty low right now.  Larger and heavier implants will eventually lower your breasts even more.  If you want larger implants just so yuo can get more fullness at the top you are going in the wrong direction to fix that.

Saline implants and large imlants will increase sagging

Thank you for sending the photos, it is very helpful.  From your photos you can see that you are sagging now.  Although all imlants can lead to sagging, saline implants tend to cause more sagging compared to silicone.  This is because they are both heavier and less compressible.  Larger sized implants, no matter what the fill, are also more prone to sagging.  Your tissues can only withstand so much.  If you convert to larger, high profile, saline implants now, you may have a temporary "lift".  This will be temporary and your tissues will start to stretch, leading to more sagging, due to the extra weight and lack of compressibility of the implant.  You can think of it as putting in a tissue expander, like we do when we need to stretch the skin after mastectomy, in order to have enough skin to put in an implant.  Just so you understand the power of saline implants to stretch the skin; we use saline tissue expanders when we want to stretch the skin to put in a breast implant for breast reconstruction as well as in other reconstructive procedures.  If you were my patient, I would advise you switch to either the gel or form stable silicone implants.  This will help minimize how much stretch your tissues will undergo, but it will not eliminate it.  Also, it is possible that you will need a lift sometime in the future to maintain the aesthetic result that you like.  Hope this helps.

Tracy M. Pfeifer, MD

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
5.0 out of 5 stars 26 reviews

4 Years Post Op, Exchanging For Larger Implants. Will They Meet My Expectations? (photo)

Even with your posted photos very hard to be definitive in our advise. Larger implants will add to the downward decent. so you may need a lifting also. Best to have a few in person evaluations with boarded PSs in your area. 

Sagging with breast implants

Jacquie, I hope you are seeing what all these other experts are saying. Gravity can't be beaten. If you go with bigger implants you are adding weight and more weight pushing against the lower skin of the breast will just stretch it out more. It is very common for patients to come to me with your contour wanting bigger implants because they want more fullness in the upper breast. We talk awhile and then I ask them to tell me how they can pour water into a bucket and make it sit at the top of the bucket. They laugh and say "You can't". Then I tell them neither can I add volume to their breast and keep it from going to the bottom.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 21 reviews

Larger implants, fuller yes, less sagging no

The larger implant will get you fuller, though you might have further thinning of the tissue and a bit more sag over time. We would favor a gel as the implant size reaches 550cc, and a moderate profile to keep the implant from appearing too round. The 'big difference' would probably be the 600cc.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 38 reviews

Breast implants exchange

With the implants you have now, you are already sagging. Remember larger implants are also heavier and put more strain on the skin to hold them up.  The likely scenario is that they will sag again.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.