Does Breast Implant Replacement Necessarily Have to Be Bigger?

Question

I'm standing 5'3" tall and weighing 112lbs. I had 230cc hydrogel breast implants 10 years ago in  front of the muscle. I went from an AA cup to a B cup. They will be replaced by silicone high profile behind the muscle.My plastic surgeon says I will need to go from 230cc now to approximately 260cc-300cc this time to ensure I'm not left with any loose skin underneath the implant. I like the size I am now and dont want to be noticeably bigger. Is it possible I would have to go to 300cc to get the job done right and would this be much bigger than I am now? Thanks.

S. Larry Schlesinger, MD, FACS · Answer

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.

Jeffrey J. Roth, MD, FACS · Answer

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.

Martin Jugenburg, MD · Answer

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

Mahlon Kerr, MD, FACS · Answer

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

Otto Joseph Placik, MD · Answer

SEE VIDEO BELOW:
Generally speaking, most patients who request implant removal and replacement desire larger implants and that is why, I presume, you are asking.
However, I occasionally see patients desiring implant removal with smaller implants. Most of these patients are pleased with their decision and a few have come back for complete removal without replacement.
The overiding concern is whether to perform a lift and generally I advise patients not to do a simultaneous lift unless their is advanced ptosis (sag).

Raffy Karamanoukian, MD, FACS · Answer

The decision to increase or decrease the size of a new breast implant is dictated by patient aesthetics and the amount of resiliency of the breast skin envelope. An increase in volume of 50 cc will not significantly alter the appearance or volume of the overall breast but may better fill the breast envelope.

Gregory Sexton, MD · Answer

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.

Tom J. Pousti, MD · Answer

It is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" 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 press 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.
	By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.
	I hope this helps.

Joseph M. Perlman, MD · Answer

If you're going from a submammary (above the muscle) to a subpectoral(beneath the muscle),the implant will be compressed more. in addition, the pocket that was made previously will not shrink down.Implants placed under the muscle tend to sit higher on the chest than implants placed on top of the muscle. If you want to stay the same size, you need to understand that there may be some sagging of the skin and that you may need some skin removed from around the areola. Otherwise, going with a larger implant will fill the skin out

Michael A. Jazayeri, MD · Answer

Your surgeon has chosen to place the new implant under the muscle.  This is a wise choice for several reasons.
First,  if the implant is placed under the muscle, it has an extra layer of protection which will make the implant feel and look more natural than if placed above the muscle.
Secondly, you will eventually need to have a screening mammogram.  It is much easier to see the breast tissue if the implant is placed behind the muscle.  
However, if the implant is placed behind the muscle, it will not fill the breast as much as if the implant is placed above the muscle.  Therefore, I think it is reasonable to go slightly larger.  If you were happy with the 230cc implant above the muscle, then 30-50cc larger will be required to maintain the same look.
300cc implant size is certainly reasonable, given your height and weight. But it really depends on how conservative you want to be, and on your chest width, height, and amount of breast tissue.
If you have a lot of loose skin and your nipples are to too low, you may need a breast lift to tighten and reposition the skin.  A larger implant alone may not be sufficient to correct the laxity of the skin.

Does Breast Implant Replacement Necessarily Have to Be Bigger?

Answers (17)

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