Breast Implant Exchange - Replacing Cohesive Gel Anatomical with Moderate Round Silicone

I currently have the Natrelle style 410 cohesive gel, form stable implants. They are 280 grams, have a diameter of 12cm, and a projection of 4.4cms. They are too big for me as I wanted a B cup and am now a DD!

I should have looked more at the projection than the gram/cc amount when choosing an implant. I now realize that I'd like a much smaller projection and am looking to replace these Natrelle 410's with the Mentor Smooth Round Moderate Silicones - 225ccs. They have a diameter of 12.2 and a projection of 2.6cms.

So I am looking to replace form stable cohesive gel implants (level III) with Mentor Moderate Round implants (level I).

Will this small decrease of 55ccs/grams enable me to avoid a breast lift? Or would the larger projection of the 410's have already stretched me out too much? Also, will the cohesive level difference in the two be an issue?

Thanks in advance.

Doctor Answers 14

Breast Implant Exchange Usually Makes Same Size Implant Look Smaller

Thank you for your question.

During a Breast Implant Exchange the Capsule around the Implant is opened and may be and usually is enlarged. The result is that even the same sized implant will look smaller after this Capsulotomy.

You will most likely  not need a Breast Lift or Mastopexy based on the photos you have submitted.

A 225 cc Mentor Moderate Profile Plus is a medium to small inplant and depending on natural breast size apparent in your photos should likely give you a B cup-however you need an evaluation and thorough discussion with your Plastic Surgeon for an accurate answer.

From Natrelle to Mentor

  • How long ago had you had your surgery? You appear early post-op in your photos: this may have a big impact on your concerns.
  • The volume differences you describe don't seem to correlate with your questions/concerns. The size diffferences you are seeing with the implant size you have chosen seem disproportionate and the small difference in implant size you are anticipating would not make a cup size change.
  • The differences you might see if you changed from Natrelle to Mentor would be relatively subtle.

Your best bet is to review your concerns with your surgeon.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 41 reviews

The best result would be with a small mastopexy

The quick answer is that yes the skin will be stretched to the current implant size. When the smaller implants are placed the pocket will need to be reduced. And, if you want the home-run result a small periareolar mastopexy will likely be needed. With that said, and depending on your age and skin tone, the skin will contract some without the mastopexy. It just depends on what you are willing to accept. I think you will like the Mentor implants. They are very natural feeling and my only choice for silicone implants.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 34 reviews

You probably can avoid a breast lift

The only way to have your breast the size and shape you are looking for it to do exactly what you have preposed. After looking at your photo it seems to me most probably you will be able to avoid a lift.

Unfortunately, the only what to know for sure is to do the surgery and she what it is like at 6 months. I believe you will be happy if you take this approach and will do well with out the need for a lift.

Good luck.

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 15 reviews

Change to a smaller implant size will not require a breast lift.

Droppin down to the size you indicate should not create a problem that will require any breast reshaping.  In my experience, both Natrelle and Mentor are similar quality implants.  I offer both products to my patients.  If I were you, however, if your breasts are soft and there is no other reason to operate, I would strongly reconsider the change in size.  It is unwise to put an otherwise good result at risk by subjecting yourself to another operation.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Change from 410 silicone implants to round gel, will I get the desired result?

Hi Sandyt123. I have several thoughts. One, it appears that you are wearing tape on your scars, which indicates your surgery is fairly recent. In the early post-operative period the final result is not visualized. Second, it would good to know what style 410 you have; it looks like either the implant is too tall for your breast (is it a full height implant?) or that the pocket is not low enough. Third, I agree with previous comments that 280cc would not take you from a less than B cup to a DD. Fourth, you will not notice a 55cc difference in volume. The volume distribution will be different if you change implant styles and this may make you happy but your total volume will be very similiar to what you have now and you state this is too big for you. If we had pre-operative photos we could be more helpful. Fifth, I do not think you need a lift. It seems your surgery was recent and even if you have revision in a 6 months or a year your skin should snap back. As it is your lower pole is tight, you want this to relax a little bit. The upper pole where you have the bulging will be fine. Sixth, the cohesion does feel different, especially if you have thin breast tissue. Some patients notice this difference. Also, the gels feel softer quicker; the 410s take longer to feel natural. I would caution you to get a second opinion from a plastic surgeon who performs a lot of breast surgery and who uses the 410 implants. My patients who have these implants are happy with them but we go through an exhaustive process to determine if these implants fit their goals. They may not be right for you but I am concerned about the volume issue in your case. Your surgeon must work with you through the implant selection process; you cannot do it by yourself. Hope this helps and don't rush into anything.

Tracy M. Pfeifer, MD, MS

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

410's versus Mentor Silicone Breast Implants

I doubt that you will need a lift from the images I see.  A 55 cc reduction is pretty small. Check with your surgeon regarding your desired goal size. On the feel of your new implants, it really depends upon the cohesiveness you desire. Mentor implants are all cohesive gel at this point. They should be a bit softer than the 410's you had.

Best Regards.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 27 reviews

Exchanging Breast Implants

Cohesive gel implants of 280 cc's should not put you into a DD. With a small drop in volume they will definitely be less projecting for you, but the overall volume will not be that much different. So whatever cup size you are now, I would think that it will not change much.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast augmentation surgeon more important than implant.


1) It is not clear why your shape is not more natural (so much fullness on top) with 280 cc breast implants, which is not a huge size.

2) I don't think just going down a little in size will get you where you want to be. I cannot tell how from the one picture, but the implant pockets need to be modified. What your breasts look like has much more to do with how the surgery is done than with the implant.

3) You certainly do not need a breast lift.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Choosing your breast implant size

Communication with your surgeon is critical in achieving the results you wish. I find that this is best done with the use of pictures as opposed to trying to predetermine specific implant size or profile.

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" 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 breast 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 “I wish I was bigger”.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 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.