Does Breast Implant Replacement Necessarily Have to Be Bigger?

Changing implants after 10 years most often requires a larger pair of implants than was first placed.  The original implants after 10 years have caused some compression of your breast and subcutaneous tissue leading to the necessity of placing larger implants on a redo to get the same result.  Secondarily, age, gravity and stretching of the skin and muscle normally require a slightly larger implant to fill up the skin. 

If you get the same exact size implants as the first augmentation, you may not get the results you anticipate.  The decision as to size of implants is always up to the patient, but I am sure your surgeon will warn you of potentially unwanted side effects.  Also, the change from a style 20, 230cc Allergan implant to a 260cc Allergan implant would cause a base width increase of 4 mm and a projection increase of 1 mm.  Therefore, although the volume would help fill the slightly larger pocket, the actual visual change should be pretty much unnoticeable. 

Congratulations on changing from hydrogel to silicone.  If hydrogel implants break, due to the nature of the high molecular weight sugars within them, they can suck all of the water out of your breasts leading to mummification of your breast tissue.  I recently published a letter in PR&S describing a case study on this subject.

Hard to comment without photos.  That being said, your board certified plastic surgeon has determined that changing them to under the muscle would benefit you.  Also you are going to go with a silicone implant.  He/she has determined with your soft tissue coverage and amount of extra skin that is would be the best operation for you.  It sounds like he has good reasons for these modifications.  Usually the small increase that he is talking about along with all the other changes will not send you into a significantly larger bra size.  Please do talk with him/her about your questions.  Best of luck.

Going with gel implants behind the muscle will seem somewhat smaller, so going with 300c will probably not make you look much larger.

Good luck.

If you are going from above the muscle to below the muscle than you need to consider the fact that under the muscle the implant will be more compressed and look smaller.  Thus to maintain you breast look, a slightly larger implant will be required.  Also realize that the shape of your breasts will change somewhat.  Going under the muscle will create a smoother take off from your chest, a more teardrop like implant.  So if you like how your breasts are full up top, you may be slightly disappointed in loosing the 'pushup bra' look a little bit

Sincerely,

Martin Jugenburg, MD, FRCSC

Toronto Cosmetic Surgery Institute

Your surgeon seems to think a larger implant will allow you to have a similar looking breast and avoid a lift which would be required for sagging skin. I use this concept often in patients who really don't want the incisions for a lift and are borderline for needing one. I'd say the change to 260cc would be barely noticeable and the other sizes would only increase a little. Since the implant will be moved subpectoral the implant will probably seem a little smaller and less mobile. Best of luck, Dr K