Breast Revision, Saline to Silicone do I ned a lift? Is it necessary ? What size is best for me? (photos)

I have seen 4 doc with different answers for my revision All agree hp silicone gel implants.I have 12yr saline 420cc Im having pain on the left as the implant is hanging.I want to go slightly bigger & have my nipples reduced in size & more even boobs 1st doc- capsulorrhapy go bigger w/nipple reduct 2nd doc original doc- capsulorrhapy ,nipple reduct 600ccs 3rd doc- capsulorrhapy 4th doc- mastopexy anchor scar, nipple reduct,capsulorrhapy I don't want a lift scar Do I need a lift Is 600 2 big?

Doctor Answers 9

Switching from Saline to Silicone and Sizing

Usually if a woman wears a size 36 AB bra and would like to be a C cup, which is the average size that women wear and the average size bra that is sold, she needs a volume of approximately 350 to 390 cc to make that change. This becomes less if she's wearing a 34 bra, because it has a smaller strap size and the cups have a smaller diameter. A smaller diameter implant would then be a volume of approximately 300 to 350 cc. In the same way if she was more petite, maybe a double zero or size one and wore a 32 AB bra, then to become a 32C cup she would only require about 250 to 300 cc. This is a general number, and of course there are other factors that will affect this.
Other factors which contribute to the outcome are #shape and #profile.
The #profile is determined by the amount of #projection versus roundness that the you desire, as well as the #size of the implant and size of your chest. Also, the placement or incision location will also have an effect on profile.

#SiliconeImplants are made with a silicone outer shell and are filled with a gummy-bear consistency silicone on the inside. More women tend to choose silicone breast implants due to the natural feel and appearance. Silicone implants are now made of a cohesive gel which are anti-leak even when cut. Look and feel like natural breasts due to the cohesive silicone gel material. New generation silicone gel implants are far superior than those used in the past and have a proven track record of safety. Silicone implants have gone through more testing than any other medical device and are the preferred choice for over the muscle implant placement. To further ensure the safety, the FDA recommends women have periodic MRI testing to ensure their silicone implants are free from any defects.

Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy. Altogether, the surgery will create an elevated, more youthful breast contour. Also, the nipple and areolae of the desired size and correct height may also be addressed. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.

Your Plastic Surgeon needs to measure you and determine the best shape and size of any implants that are used. Any cosmetic #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome.  Your procedure should always be performed by a #Plastic Surgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for another revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient #reviews. Gathering all of this information will help you make a well-informed decision.

Orange County Plastic Surgeon
5.0 out of 5 stars 107 reviews

Implant revision from saline to silicone with a lift and nipple areola reduction

  • When implants have been in for many years and you are no longer pleased with the shape- changing them is a reasonable thing to do. I have never had a patient regret going from saline to silicone implants. Current gel implants are softer, show less ripples in thin patients, and have a very high patient satisfaction rate
  • In your photos, I think going for great symmetry of the shape and reducing the nipple diameter to make them equal is a great approach.  I would caution AGAINST high profile for you.  The HP implants will exert strain on your nipple incision resulting in spreading and less-than-ideal outcome.  
  • A small lift may be needed based on your side view pictures- but a plastic surgeon can decide in person. It is not easy to tell with photos alone
  • Please see a plastic  surgeon who  does a large number of replacement, revision and reconstruction cases a year.   The chance of an outcome that require revision surgery within a few years is relatively high with replacement surgery. So go with the best and  busiest.  
  • Best wishes for nice outcome.

Michael Suzman, MD
New York Plastic Surgeon
4.8 out of 5 stars 27 reviews

Best breast implants for revisionary breast surgery?

Thank you for the question and pictures.   You will find that online consultants will not be able to provide you with specific advice in regards to selection of specific breast implant size/profile. Ultimately, careful communication of your goals will be critical.

Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery (regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals.  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 "D or DD cup” etc 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.   

3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery ( after the use of temporary intraoperative sizers).  Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select  the best breast implant size/profile for the specific patient. I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

New implants and a lift?

Hi and thank you for your question. From the pictures you provided it looks like your skin envelope is already fairly tight. You might not have sufficient skin to increase your implants from 400 to 600 cc's. I think you would benefit from some modifications to your breast shape, lifting your nipples a bit higher and reducing the size of your areolas. I think it's more important to focus on the changes that will make your breasts prettier than to focus on the size.  I think you would likely get a nice result with a donut mastopexy and implants in the 400-500 cc range. If you haven't found a plastic surgeon you are confident in yet then you should keep looking. Good luck to you. 
Dr West

Justin West, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 28 reviews

Redo breasts augmentation

Dear Nicole,   Thanks for submitting your pictures and sorry for your problems. From observing your pictures, you appear to be small C cup, with bilateral capsule contracture, very wide cleavage and level 2 ptosis with very large areolas.    I have been in practice for over 29 years and performed breasts augmentation surgery on thousands of patients. I must disagree with all your consultants. My recommendation to you will be as follows: 1. Convert to sub muscular pockets, if yours are currently sub glandular. 2. Use smooth , round moderate profile saline implants 3, If your pocket are sub muscular, perform superior, medial and inferior capsulotomy (scar release) , to make room for larger implants and give you nice cleavage. 4. Bilateral mini lift (donut, Benneli) that will make you perkier, symmetrical and give you smaller and more attractive areolas. 5. Based on the pictures, there is no need for capsulorrhaphy (internal bra). 6. You did not provide your chest circumference measurement in inches, which is critical for the correct selection of implants size according to your desire. Lets assume that you are presently, 34 small C cup size. To become 34 full C cup (very nice size), you will need 550 cc implant. For 32 full C - 500 cc.    Your situation is not simple and you should do your due diligence very carefully, especially because of your initial bad experience. This time choose your surgeon wisely , to avoid another redo breasts augmentation.    Always, consult with experienced board certified plastic surgeons who perform lots of redo breasts augmentation surgery in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking. Also, check the reviews on 'RealSelf' for ratings and positive experience reports.                             Best of luck,                                                Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 124 reviews

Circumareoalar approach

I think that a circumareola approach which will allow for areola reduction and implant exchange should be possible.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast implant exchange and lift

Hello and thank you for the question and the photos. Based on the photos, you are a good candidate for an exchange to silicone gel. Your skin and soft tissues are thin, and I would suggest a textured implant. Your photos seem to show that the implants are above the muscle. Repositioning them to under the muscles will generally look better and less "implanty". Having said that, I think the 600 might be a bit too much for your frame. Lastly, I would also recommend a lift. I would avoid the nipple scar, first placing the implants from the inframammary incision, then finishing with a full mastopexy. There is enough loose skin and sagging that a lift will be beneficial to you. I know that no one wants the extra scars, but there are times when it is necessary. 

It's not uncommon for several docs to give you very different options. We all have a particular preference on how we do things, and what techniques we depend upon for a successful outcome. As always, best to be healthy, no smoking, and make sure any health concerns you have are managed by your primary care md. Best to you. 

Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 21 reviews

Augmented Breast Revision - Do I need a Lift?

To get as close as possible to the ideal breast you can obtain, you must asses what you have and how to improve upon it. If you critically asses your present chest, you appear to have implants which are too large for your chest (they appear to be sliding sideways into the path of your arms) which have greatly stretched and probably thinned yiur Areolas and already created breast sagging. ( Even with back arched backwards your nipples are lower than the mid portion of the breast and are pointing down. 
A lot of what is wrong with this breast may be the result of using large implants which are exceed the underlying chest frame (falling sideways) and stretching everything in front of them resulting in huge Areolas and then by sagging. It makes no sense to try and fix the problem by overlooking the major cause for it. I therefore think you should look at high profile and ultra high profile gel implants and pick one that fits your chest. I would then make the overlying breasts fit the implants. This would require tightening the present capsule( to keep the implants from falling sideways and keep them pointing forward), the breasts may need to be lifted and the Areolas need to be reduced to a more attractive 4cm diameter. 
Approaching your breasts in such a planned logical way is the only way to get the best breast. 
Dt. Peter A. Aldea
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews


Bigger implants will give you some lift.  It may not lift them as much as you want.  The size implant is your choice.  You would choose larger than 420 if you wanted to be bigger.  If you want your nipples reduced, you will get a scar around the nipple.  You would need an additional vertical scar to lift the breast.

Tyler C. Street, MD
Napa Plastic Surgeon
5.0 out of 5 stars 3 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.