Want to Increase Existing Implant Size - Size? Saline or Silicone?

I had breast augmentation 1 year ago and the implants were too small. I'm planning to have another surgery to increase the size of my breast. I currently have 350ccs and plan to increase to apprx 450-500ccs. This time around I would like silicone implants; however, I wasn't aware that high profile silicone implants are not the same size as saline implants although same amount of ccs. Do I need to go much bigger for silicone implants to achieve the desire look of saline implants?

Doctor Answers 8

Breast implant sizing saline or silicone?

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

Thank you for the question.

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.

Gel appears smaller then saline size for size

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

When exchanging gel implants for saline implants you generally want to go up at least 50 cc more than you would with the same sized saline implant.  For some reason gel appears smaller.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast Implants

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

Multiple measurements need to be taken to fit an implant to your exact anatomy.  Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer.  Then you and your surgeon can piece together the puzzle by matching your measurements, with you wishes, versus your tissue cover and the available implants to arrive at a surgical plan. Keep in mind upsizing your implants can cause problems in the future.  I would suggest you only have revisional surgery if you really, really want it.  The volume of a saline implant of 300 cc is the same as the volume of a silicone implant of 300 cc.  The different diameters and profiles may better fit your breast width and chest wall width.  Silicone has less wrinkling and may be your best bet for this reason.  All the best, "Dr. Joe" Gryskiewicz

You might also like...

Breast Implant Selection

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

Although implant volume (cc’s) is important, the shape of the implant is just as important. Implant shape has two components. One is the base, or how much space the implant occupies on the chest wall. The other is projection, or how much the implant stands out from the chest wall. For example, a 350cc implant can be moderate profile or high profile.

  • Moderate Profile Implant : The moderate profile implant will occupy a larger diameter of your chest wall, it is wider and taller. It will not project outward so much, as it is distrubuted in a flatter, wider fashion.  This implant is often chosen by patients who want fullness to the side of the breasts. In the video snapshot below, this profile is that implant to your right.
  • High Profile Implant: The high profile implant will occupy a smaller diameter on your chest wall as it is narrower but it also stands out more from the chest wall. This implant is often chosen by women who are slender and want more projection outward, instead of fullness on the side of the breast. In the video  below, this profile is the implant to your left.

For more detailed information, watch the video where I discuss high profile and moderate profile implants or see the web reference where I discuss all of the factors women need to consider before selecting breast implants.

Ricardo L. Rodriguez, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 98 reviews

Breast augmentation

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

The dimensions of saline and silicone implants afe different even for the sane volume.  An experience plastic surgeon will analyze you body and determine what the best implant are than can fit you frame.

David L. Abramson, MD
New York Plastic Surgeon

Breast implant remove and replace: saline to silicone

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

This is not a simple yes or no answer. Depending on the manufacturer and stlye (moderate vs moderate plus vs high profile). The choice of an implant is complicated by the variety of sizes available. Use some of the sizing charts to help you in your decision and find a breast implant with a similar diameter if you are pleased with the current breast width. If desiring a fuller breast increase the diameter of the implant accordingly until you achieve the size you are seeking.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Changing Breast Implants From Saline to Silicone: What to Know.

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

The most common reason for revision breast augmentation is a change in implant size.  Breast implants are not like tires and do not need to be changed out every 10 years, however your change is fairly early. Going from saline to silicone, both implants look the same however silicone feels more natural. When performing revision augmentation I would always upsize to accommodate for the inherent relaxation of the breast tissue. You have to find out what profile breast implant you have in and when you consult with your plastic surgeon discuss implant shape. A high profile implant, either saline or silicone will likely be the same width as your pre-existing breast implant though provide more projection. ie they will stick out more. If you are thinking about an early change and a high profile implant I would assume you would likely be happy with more volume than you have suggested.

Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Silicone vs Saline Breast Implants

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

 Your surgeon can give you your desired look with Silicone Implants. I would trust their judgement with regard to final size and style. The difference between saline and silicone is feel, not so much any visible difference. The silicone high profile implants look beautiful. The style chosen depends mostly on your breast width, and desired cup size.

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.