Implant Size, and Saline or Silicone Revision

i had breast aug january 13, 2010. i am 5ft7in, weigh 135. i got mentor 400 mod plus saline filled to 400cc. slight asymmetry before surgery left breast crease lower. i was a deflated a after breastfeeding. unhappy with my results. i still have asymmetry and ugly incision scar on left. want to go bigger. not sure about saline or silicone. would you lower right crease or raise right? does left look bottomed out? wanted either mentor 500 mod+ saline or 500 hp silicone. thanks

Doctor Answers 7

Breast Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 I understand you are considering larger implants.  Larger implants will likely result in a more visible lower breast fold scar (scar often rises up). If you do get larger implant the PS will likely lower the  right breast and may increase the size of the implant pocket.  Given your very thin skin and preop breast tissue, I would be inclined to continue using silicone though I would consider using Natrelle Style 45 (very high profile implant) so that you get bigger breasts without having to go much wider.  This will make it less likely that you will have lateral (side) displacement of implants over time.

Asymmetry after breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
You will always have asymmetry. Most, if not all women have asymmetry  before breast augmentation and most, if not all women do after breast augmentation.  If you look hard enough, you find asymmetry in pretty much everyone (except magazine models who are photo shopped to no end!).  

I see a very nice result in your photos.  Any operation has its down sides. Consider how you would feel if an infection in your next operation required removal of your implants (it can happen).  So weigh your options carefully before proceeding.  Best of luck. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Breast implant revision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Wow, I cannot believe that you are not pleased with your result and that you want to go bigger.  You have a really, really good result.  Trying to improve on this is not in your best interest.  If you were my patient, I would say "nooooooo way".  I think most experienced plastic surgeons would agree with me. 

Breast implant revision has a much higher revision rate that initial breast implant surgery and the more revisions, the higher the revision rate.  I'm not saying to leave "well enough" alone.  I'm saying to leave "really, really good" alone.

Oh, don't go bigger.  You are plenty big already, even for Southern California.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Breast Implant Revision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Many factors need to be taken into consideration when performing implant revision.  Not the least of which is your current appearance and what your expectations are.  Based on your photographs, you have a very nice result from your implant surgery, and on a scale of 1-10, with 10 being the best possible result, you have a 10!  Well, it is hard to improve on a 10 with another procedure and in fact you may end up with a result that is less than a 10.

Having said that, there are reasons to undergo a revision.  If you do not like the "feel" of the saline implants, silicone will give you a much more natural feel.  If you want to go larger in size, make sure you pick implants big enough to give you a noticeable change, otherwise why undergo another procedure.  In my experience you will need to increase the size of the implants about 50% more than the original size.  In your case you are looking at a 600cc implant (400 + 200=600).  A high profile implant is fine, but remember, what in gain in projection, you lose in diameter and subsequently fullness in the upper pole and cleavage area.  Also, if you have an "ugly" scar that can easily be improved with a scar revision procedure at the same time as the implant exchange.

Please sit down with your PS and review all the options, you may want to look at the exact measurements of the implants from the manufacturer before making your decision.


Good Luck

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 82 reviews

Breast implant sizing

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 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" 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.


I would not recommend larger implant

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have a good result based on the attached pictures. Your before picture shows that you have small amount of breast tissue. You do not have enough tissue to cover your implant and larger implants will  cause more thinning of the skin and more palpable implants.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Breast creases

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It looks likethe left creast was always lower than the right, but not by much. If you try to lower the right, you may cause a double bubble.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.