I have saline under the muscle and no upper pole cleavage - should I switch to silicone? (Photos)

Question

I am doing some research into finding a doctor to go to for my breast augmentation I had my breast done about 10 years ago. I had a child two years ago and I have noticed that they are signing a little bit and I feel as if I don’t have much upper pole fullness. I currently have saline under the muscle. If I am looking for them to sit higher up on my chest would switching to silicone be best? Thank you in advance.

Gregory A. Buford, MD, FACS · Answer

The simple answer is no.  Simply switching to silicone breast implants is going to have little to no affect on your upper pole volume.  Instead, a little trick I have used to increase upper pole volume is to reduce the distance from the nipple to the breast fold by performing a Base Wedge Excision.  For the right patient, this not only decreases the lower pole of the breast but also gently pushes the implant into a slightly higher position giving more upper pole projection.

But for this to be succesful, you have to have an appropriate amount of lower pole distance or it will look funny.  So an in person examination is really necessary to see if this would work.

If your nipples are sitting too low, then a full breast lift may also be an option.  But again, it's really hard to tell from a single photo.

I would suggest consulting with a Board Certified Plastic Surgeon who specializes in secondary breast surgery and who has experience with a number of different procedures and not just the lift alone.

I hope that helps and wish you the very best in your surgical journey.

Mert Demirel, MD · Answer

Switching from saline to silicone may improve the feel and sometimes the naturalness of the implant, but it will not automatically make the breasts sit higher on the chest. Implant material alone does not correct sagging or low implant position.
If your breasts have dropped after pregnancy and you have lost upper pole fullness, the real issue may be skin stretch, implant pocket changes, breast tissue descent, or nipple position. In that case, the options may include an implant exchange, pocket revision, a different implant profile, and possibly a breast lift.
If the nipple position is still acceptable and the main problem is volume loss, a silicone implant with an appropriate profile may help restore some upper fullness. But if the nipple or breast tissue sits low, simply switching to silicone may give you a softer implant but not a higher breast.
Since your implants are 10 years old, it is reasonable to have an in-person evaluation. The surgeon should assess implant position, capsule, nipple level, skin quality, and whether the pocket needs tightening. The best result may come from silicone implant exchange with pocket adjustment, and if there is true sagging, a lift may need to be discussed.

Ira H. Rex III, MD · Answer

It is very difficult to make any recommendations from your photograph.  It is my best guess that you may need to reposition the implants higher and lift the breasts.  If you get new implants, they could be either silicone or saline and produce pretty much the same effect.

Semih Yildiz, MD, FEBOPRAS · Answer

The photo shows some breast asymmetry and lower-pole skin relaxation, with the implants sitting lower on the chest and limited upper-pole fullness. A mirror photo cannot show the exact nipple-to-fold relationship or pocket condition, so an in-person examination is important.

Changing from saline to silicone may give a softer feel, less visible rippling, and a different implant shape, but the fill material alone will not lift the breasts or move the implant pockets higher. The plan may need to address stretched skin, pocket position, capsule condition, implant width and projection, and your natural chest anatomy. Depending on those findings, options can include implant exchange with pocket adjustment, internal support or capsulorrhaphy, and sometimes a breast lift. Fat grafting may help camouflage selected areas but is not a substitute for correcting a low pocket or significant skin laxity.

Ask a board-certified plastic surgeon who performs revision breast surgery to examine you standing and review your original implant information. The best revision should target the cause of the low appearance rather than assuming silicone alone will create upper-pole cleavage.

Yasemin Aydinli, MD · Answer

I had a look at your photo. Your implants appear to be in a reasonable position, and what you are noticing seems to come mostly from your natural tissue, which has settled slightly after your pregnancy and emptied the upper pole. Switching from saline to silicone will give a softer, more natural feel, but the material itself will not make the breasts sit higher. What would actually address your goal is the combination chosen at exchange, a higher profile implant, adjustment of the pocket toward the midline, and if the settling progresses, a small lift alongside the exchange. An in person examination would show which of these applies in your case.

Gary M. Horndeski, MD · Answer

The type of implant will not change the position of your breasts. Your breasts are wide and low on your chest wall. At this time, I recommend explantation and breast lift using the Bellesoma. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Manuel Diaz, MD · Answer

Helloo. I can see some loss of upper pole fullness and mild breast sagging, which is very common after pregnancy and breastfeeding. 
Changing from saline to silicone implants can certainly provide a softer feel and may improve fullness, but the implant material itself will not lift the breasts. The amount of upper pole fullness you achieve depends more on the implant size, profile, and your breast anatomy than on whether the implant is saline or silicone.
From what I see, you may benefit from a breast lift in addition to replacing your implants to restore a firmer, more youthful shape and improve the position of the breast tissue. This combination would provide the most balanced and long-lasting result.

Camille Cash, MD · Answer

It's difficult to provide a specific recommendation without an examination.  It appears that the lack of upper pole fullness is likely from the tissues settling naturally with age and after pregnancy.  Switching to silicone may provide a softer feel to the implants but it will not provide upper pole fullness.  Undergoing an implant exchange with a different profile or perhaps having a lift may be the better solution.  Visit with a board certified plastic surgeon near you to learn more.

I have saline under the muscle and no upper pole cleavage - should I switch to silicone? (Photos)

Answers (8)

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