Saline implant to silicone & curious if I need a lift at time of exchange? Could I get away with a donut maxopexy? (Photo)

I'm 5'6" 126lbs 32D; before my implants I was 34B. I had my saline 330 filled to 390cc in 2008. 2 kids & breastfed. My areolas have stretched out & I'd be good w/them being smaller. I talked to my PS about an exchange she said she could deflate my saline implants in office to let skin tighten up then do an exchange 500cc 6-8wks later w/out lift but later down road I might still end up needing one. Should I even worry about doing the deflation process or if needing a lift--which one? Thanks!!!!

Doctor Answers 8

Redo breasts augmentation

Dear sk,   Thanks for submitting your picture.   Your breasts appear very unnatural because of the constricted look due to capsule contracture and you areolas  are too big. I disagree that you were 32 B cup size, because you received 390 cc implants which would have increased your breasts by 3 sizes, to 32 DD. Since you are 32 D you must have been 32 A cup size.  As far as the surgical plan by your doctor, it does not make sense, unless you want to become 32 DD. Additionally, if your implants are sub glandular, I would recommend to place them sub muscular  and do mini lift (donut, Benelli)  procedure at the same time. If your implant are sub muscular, you need capsulotomy (scar release ) and mini lift at the same time. Implants size should stay the same or increase only slightly and keep them as saline implants.  Since your surgeon seems to lack the necessary experience, your best mode of action should be to consult with other experienced  board certified plastic surgeons who do lots of redo breasts augmentation in accredited surgery center for your safety. Most importantly, check the before and after pictures 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

McLean Plastic Surgeon
4.8 out of 5 stars 126 reviews

Breast Implant Revision

Thank you for your question.  Your current implants look very spherical and unnatural; curious to know if they're under the muscle or not.  If you're going larger to 500cc, it is unlikely that you'll need much of a lift.  Certainly a donut lift can help reduce the areola size and adjust the nipple position.  There's no need to deflate intact bilateral saline implants and "tighten skin" if you're planning to exchange to a much larger size.  Tightening and contracting skin will just make it harder to accommodate larger implants.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck.

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 19 reviews

Saline implant to silicone & curious if I need a lift at time of exchange? Could I get away with a donut maxopexy?

I do not see anything in the photo that makes me think you would need a formal lift, although a Benelli procedure to reduce areola size is reasonable if that is one of your goals. I also see no reason to deflate the implants "and let the skin shrink" if you are going with larger implants. That would be a good idea if you were downsizing.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast lift

If you are planning on having 500 cc implants placed, then you may be able to undergo a donut mastopexy at the same time to reduce your areolar size.  This will not lift the implants significantly.  The end result will be larger implants in a similar position on your chest wall as your current implants.  You may consider a vertical lift that will lift your implants higher on your chest wall and reduce your areolas.  For this vertical lift, however, you would need to consider slightly smaller implants than you have now.  Best wishes, Dr T. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews


I personally think the deflation is a good idea. I've been impressed with the amount of skin tightening you can get with that procedure. I would caution you against putting in a 500cc implant however because of the thin nature of your soft tissue envelope on top of the implant. Do you have any fat on your body that could be used for fat grafting?

Edward S. Gronka, MD
Fayetteville Plastic Surgeon
4.7 out of 5 stars 13 reviews

Saline to silicone

Thanks for your question! I really enjoy doing surgeries like yours, although they can be somewhat challenging unless you do a lot of implant exchanges and revisional surgery. 
I don't necessarily think that you have to go through the whole deflation process, although that's certainly not a bad option. 
I would exchange you from saline to silicone, go up one profile and a little more cc volume, do a capsulorrhaphy to move your implant pocket more up and in, and yes I would do (and you only need) a donut mastopexy, which in my experience of doing over 1,000 of them, hides the scar very nicely between the darker areolar skin and the lighter breast skin (make sure that your PS uses a permanent suture to aid in this procedure). Best of luck to you!

Robert P. Schmid, MD
Lubbock Plastic Surgeon
4.9 out of 5 stars 39 reviews

Saline implant to silicone & curious if I need a lift at time of exchange?

Thank you for the question and picture. I think you could proceed either way. Having said that, everything considered, I think that in office deflation is a good idea in your case.

Generally speaking, in office deflation of saline breast implants is an option for some patients. For example, if a patient wishes to downsize breast implants and/or undergo breast lifting surgery, it may be in her best interests to have an in office deflation performed; doing so has the advantage of allowing the skin to “bounce back” slowly. Both the patient and her plastic surgeon will be able to determine more accurately, what will be in her best interests with subsequent surgery. Planning of additional surgery, such as breast lifting, may also be and easier and more accurate proceeding in this fashion.
In office deflation may be a good idea for patients trying to decide whether to undergo breast implant removal altogether or downsizing of breast implants; this will give them a good idea of what their breasts will look like without implants.  Obviously, in office deflation does commit patients to additional surgery (at the very least, breast implant shell removal). Sometimes as breast implants deflate, patients report discomfort as a breast implant edges irritate the surrounding tissues.
My best suggestion: select your plastic surgeon carefully.  Ask to see lots of examples of his/her work achieving the types of outcomes you will be pleased with.  Communicate your goals carefully as well. Working together you will devise the best plan to achieve an outcome that you will be happier with
I hope this, and the attached link, helps.

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


Your breasts appear very spherical.  We see this with maximally inflated saline implants which get rounder as they are inflated.  The same effect can occur with capsular contracture.  As the scar tissue tightens on the implant, it generates equal pressure in all directions, resulting in a sphere.

In either case, deflating the implants progressively prior to surgery by placing a needle and withdrawing fluid, will usually result in a dramatic shrinking of the breast tissue.  Switching to a moderate plus profile silicone implant above the muscle may offer significant improvement if capsular contracture is not your problem.

The actual type and size of implant is best determined at the time of surgery by inserting "sizers" and determining the best looking.  So don"t get hung up on size and shape.

This video link will show the effects of over inflating implants

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.8 out of 5 stars 10 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.