Implant exchange (saline to silicone). Which silicone? How big can I go and still look good? (photo)

I am switching to silicone implants due to the excessive rippling with the saline and how easily the bag can be seen and felt. I am 31 years old, 115 lb, 5'8. I want them to look as realistic as possible but I would like to go as big as possible too. I'm hoping to end up with about a DD. Before any augmentation I was a mid 34 B. After my first augmentation I was a full 34 C. When nursing I was a 34 F cup. I have wide shoulders but a narrow chest, long torso and long legs. I'm always between 112-120 lbs.

Doctor Answers 8

Implant Exchange with Mini Ultimate Breast Lift(TM)

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
22% of women who undergo breast augmentation alone require revision within 2 years because they are dissatisfied with the result. Dissatisfaction comes from multiple factors but in your case, your dissatisfaction is coming from the fact that they are bottoming out. More important than implant exchange is repositioning your breast higher on the chest wall. You need a lift more than implantation. I recommend a new technique called Implant Exchange with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant. Small round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it. At size 34 each 100 cc’s of implant corresponds to 1 cup size change. Prior to implants you stated you were a B. 200 cc implants would take you up 2 cup sizes to a D and 300 cc implants would take you up 3 cup sizes to a DD.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Choices when switching and upsizing...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thanks for your photos as they show a hint of 'bottoming out'.  Are you hoping the larger implant will rectify this?  If your tissue is already thin, larger implants will only contribute to that process necessitating more surgery (lift and downsize) in the future.  If your size is 'good enough', consider having an overlapping inferior pole mastopexy to help improve the breast shape and provide more tissue coverage.  Be cautious of what you want here...

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Implant exchange

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Revision augmentation is always a challenging case. Without the benefit of an exam it appears that your implant has bottomed out. I would set up a consult with your plastic surgeon and discuss your options. I would caution you about choosing an implant that is too large because it will cause further stretching of your soft tissue. Good luck.

Arun Rao, MD
Tucson Plastic Surgeon
5.0 out of 5 stars 19 reviews

Best size for silicone breast implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
As I look at your pictures I would consider your case to be difficult. You do have some bottoming out of the implant which has thinned the tissues which increase the risk of rippling. Larger implants will fill the upper and medial poles better but even with silicone you risk rippling because of the thin tissue, especially as the implants get bigger.

This is definitely a case for an experienced board-certified plastic surgeon who has done a lot of revisional surgery. Be sure to research this prior to consultation.

Bigger may not be better

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Dear MS McGee,

I would encourage you to get several opinions before proceeding with your plans feeling that bigger will be better. Larger volume implants may threaten to further attenuate your breast soft tissue envelope which would obviate reaching your stated goal of looking as realistic as possible.  Having a consultation with an experienced plastic surgeon who could assess your situation is best.  Proceed with caution.

Craig Harrison, MD, PA
Tyler Plastic Surgeon

Pocket repair and implant exchange

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Dear BT McGee,

Thank you for the question and the photos.  You will need pocket repair as well as implant exchange to accomplish you goals.  You have several options including:

1) implant and capsule removal, healing, and second stage re-augmentation
2) pocket repair (capsullorhaphy) and implant exchange

With regards to implants.  If you select option 1 then for your second stage I would consider shaped silicone implants (gummy bear implants).  If you decide on option two you may be served best by round silicone implants.  Pocket repair of this size  may require a small revision to fine tune the pocket shape.  Take a look at the before and after photo link of one of my patients.

All  the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Uh oh...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Looks to my eye (and your pics aren't perfect so its hard to commit) that you have some bottoming out. By that I mean that your implant sits too low on your chest. This gives the appearance that your nipple is too high. It can also increase rippling because your implant sits so low there is little breast tissue to cover it. Going with a bigger implant is the WRONG thing to do since this will increase the weight on tissues which have shown themselves to poorly tolerate the implants you currently have. While temporarily, you will have more "superior pole" fullness, as the implant drops you'll have the same look again and it will be even more difficult to fix. I would consult with a surgeon who has specific interest in repair of bottoming out and revision of breast augmentation. Good luck

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 43 reviews

Implant choice

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I think that the only way to determine what the best implant would be for you, is to go for a consultation in person to be properly evaluated.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.