Existing Saline Breast Implants - Would Like to Have a Lift/reduction/new Implants, Which Would Be Best For Me?

I have existing saline implants done in 1996 placed behind the pectoral muscle - Natural breast-size was 34C but wanted perkier breasts. But, didn't turn out perky after surgery at all.They have gotten droopier, heavier, oddly shaped, nipples aren't centered, etc. What procedure would you recommend? Reduction and/or Lift? Will I need new implants? Would love to finally have perky youthful natural looking breast, my existing scars are under armpits and I am concerned about scars on my breasts.

Doctor Answers 12

Switch your salines out for silicone gel implants

Your breasts will feel and look better if you switch them out to silicone gel implants.   Looks like you would also benefit from a breast lift.    I would have to examine you and make some measurements to suggest the best type of lift.  Another approach is to remove the saline implants, not replace them and simply lift your breasts.  It all depends on how you feel about this new larger size.   How large are your salines now?  Do you like your size now better than before?  If so, keep the implants.  If not, get rid of them.  Hope this helps.  Good luck!

Dr Grant Stevens 

Los Angeles Plastic Surgeon
4.7 out of 5 stars 145 reviews

Breast asymmetry is distressing

The conventional wisdom is that breasts are never identical twins but should ideally be "sisters".  Your breasts are unmatched from nipple position, volume, amount of skin, and lie and the differences may have been getting worse over time.  Your initial surgery was a transaxillary breast aug and while this approach doesn't leave a scar on the breast, it has several shortcomings, the principal one being difficulty with revisional efforts.  In other words, scars on the breast will be necessary to produce your objective of equal volume, balanced nipple position, soft perky breasts.  Consult with PS, armed with photos of your desired results and ask their opinion.  Your photos appear to suggest that you need bilateral implant exchange (saline to silicone); possible left open capsulectomy (removal of scar tissue) and mastopexy.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Revising previous breast augmentation

Based on the history and photos it appears that your implants are doing fine but you've gained some weight or tissue and the right breast has sagged relative to the implant. This is not bottoming out but represents natural sagging. It's not clear why the left side didn't do this as the position of the left breast to the implant is fine and could be adjusted by changing the implant dimensions and the capsule surrounding the implant. In the absence of active capsule contracture it is not necessary to remove the previous capsule but there are more options for implant dimensions today then there was in '96 and "perkiness" can be achieved by an appropriate implant width and projection on the left along with some adjustment of the implant capsule with modest increase in breast size. The right side probably needs a lift for position and symmetry but an exam is necessary to see how much sagging is present and how much asymmetry can be tolerated. The simplest procedure with the least scar would be manipulation of the implant space through an inframammary crease incision and replacement of the implants with different dimensions available today. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Existing Saline Breast Implants - Would Like to Have a Lift/reduction/new Implants, Which Would Be Best For Me?

Based upon the expertly posted photos you will need a full anchor lift and replaced implants. Sorry but there can be scars. Best of luck seek opinions in person from 3 boarded PSSs in your area. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

You will need breast lift and new implant

Your pictures show a lot of skin and low nipple position. You will need full lift and new implants. There will be scar around the nipple-areolar complex and also a vertical scar.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Breast lift

From your pictures, it looks like you may have some capsular contracture (hardening of the implant scar tissue) which is making the shape less round and soft.  If that is the case, you would need to have the scar tissue removed which will improve the natural look, feel and shape of your breast.  A lift will give you the best look for sure - this will leave scars on your breast but they fade very well with time.  Good luck!

Bivik Shah, MD
Columbus Plastic Surgeon
4.4 out of 5 stars 26 reviews

Breast implant revision

First of all, you need to move beyond the concern about scars on the breasts because you need a full lift to tighten the laxity, raise the nipples and improve the symmetry.  Without examining you, I can't say anything about exchanging the implants but this is commonly done too.  But implant exchange alone won't help you at all because of the tissue laxity you have.  A well performed artistic lift will give you a great result.  Make sure you go to someone who can show you lots of early and late photos so you can see their work as this is very surgeon dependent.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast lift, new implants?

From what I can tell from your photos, you have a fair amount of asymmetry and a lax, large skin "envelope".  Many patients, in an attempt to avoid additional scars on the breasts, try to avoid a lift and instead ask to have their loose skin "filled out" by larger and larger implants.  Unfortunately, this usually leads to large, saggy breasts as opposed to "perky" ones, and their thin, damaged tissues continue to stretch and thin under the weight of the implants.  It is good that you have, on your own, come to realize that the answer may be to reduce the loose skin envelope by having a breast lift, even at the expense of scars on the breast. It is difficult to tell from your photos what your breasts look like when your arms are down, how much of that asymmetry is only when your arms are lifted, etc.  Even with a breast lift (to elevate the nipple position, reduce the overhang of the breast, tighten the lower pole of the breast, hopefully achieve better symmetry), you will still need implants of a decent size to fill out your tissues, since no breast lift tightens the mid to upper portion of the breast very well in a patient whose tissues are quite deflated and stretched.  A board-certified plastic surgeon should be able to evaluate you and discuss your options, with the limitations and risks of each option.  Remember, if it sounds too good to be true, it probably is!

Robert M. Grenley, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 87 reviews

Breast implant revision

Based on the history and photos you will likely require, at the very least, a breast lift (mastopexy).    If the breasts are firm you may also have hardening, capsular contractures.  If this is the case, you would want to also replace the implants and remove the internal capsule.  If you would like smaller breasts as well then you would need to reduce the size of the implants, or possibly reduce the existing breast tissue(less likely).

Steven S. Carp, MD
Akron Plastic Surgeon
4.6 out of 5 stars 32 reviews

Breast Implant Surgery Revision Options?

Thank you for the question.

You will do much better with an in-person consultations then with online consultants.

Breast implant exchange and breast lifting will likely be necessary to improve your best shape and symmetry. As you know, the downsides of the procedure will involve scars on the breasts;  the upsides include improvement in size/symmetry/ shapes of the breast. If and when you are willing to accept this trade-off will be the time when you should proceed with revisionary surgery.

Your surgery  will not be “simple”;  make sure you are working with well experienced board-certified plastic surgeons who can demonstrate the results of surgery previous patients have achieved.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 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.