Revision due to saline implant deflation. Should I get 650 HP silicone gel Inspira?

What size or profile implant depends on your dimensions, not just hypothetical desires. Further, having had various sizes over a long period of time requires analysis of your implant pocket and the soft tissue envelope covering your implants (your breasts). In other words, you need an expert to tell you what works and what doesn't, and that expert should be explicit as to why, and not just their word. You may need more than a simple remove and replace. As for implants, Inspira is great, but Motiva is better. Take my word; I'm one of the surgeon investigators that got that implant FDA approved.

Dear Persistent541516,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

If your skin is stretched out then adding a large implant, such as 650 cc, will most likely cause problems in the future. You have had several procedures already and you need something more permanent. Unfortunately, you have not provided photographs. You may want to consider explant with breast lift and then implants placed sub muscular. I need more information to give you an accurate answer.

Best Wishes,

Gary Horndeski, M.D.

You have large implants now and I would suggest going somewhat smaller, maybe down to 600 and tighten your pockets. You might prefer gel implants, but the bag can still break.

In my experience, saline implants deflating prior to rupture has been unusual.
Personally, I prefer to surgically intervene as soon as possible, if my patients have a leaking or deflating saline implant. As the implant deflates, the capsule or implant pocket will begin to shrink and replacing the implant with a similar size becomes more difficult passes without opening the capsule.
Perhaps a bit technical.
The bottom line is I like to operate ASAP when I have patients with ruptured saline implants.
If the deflation happens early after the surgical procedure, then damage to the implant from puncture from one of the suture needles should always be considered.
Most patient silicone implants because of the better look and feel of the implant.
Silicone is not going to leak or the flight, but all implants will eventually rupture and fail.
Without including before, and after pictures, we can’t really begin to make an assessment.
As a general statement, using large implants is going to of undesirable, side effects, complications and need for revision surgery.
This however, does not include saline implant deflation.
Best,
Mats Hagstrom MD