Exchanging implants from saline to silicone. Do I need to go slightly larger?

Hello,You are the perfect candidate for an 'overfilled' silicone gel implant.  These devices are designed for you in mind: to achieve the same bubbly look of saline in a silicone gel implant. Unfortunately, Sientra doesn't make one yet. Mentor is about to come out with one, but the only one actually available is Natrelle's Inspira line of implants. In the past, what your surgeon recommended was the only alternative. Best of luck!

Saline breast implants can be changed for silicone breast implants - its a simple procedure for patients that do not have issues with capsular contracture or implant malposition. I generally recommend swapping implants for smooth round silicone implants in revisionary breast surgery.

so your question suggests you may have a capsule that creates a firmer feel.  Releasing the bottom half of your breast confirms that some release of your tissue is needed to achieve a look that is aesthetically pleasing.  You do not need the super cohesive gel implants that don't change shape - do you want a circular mound that is fake?  If you can accept the concept of being an ounce or so larger, you should.  It will not make any difference in your ability to maintain your active lifestyle.  If you don't mind possibly being a little smaller in look, then keep the switch even in terms of dimensions and volume.  And if you have a contracture issue,  you should be asking your surgeon for other ways to help prevent its recurrence.  BTW, I loved the PIP implants and am surprised yours are still intact.

You must be very cautious about making your implants larger IF you are already happy with the size.  Sometimes surgeons will advocate a size increase if they believe that the shape will be better with a larger implant.  However, this WILL make you larger, and if you are already comfortable with your size, you may be unhappy after the surgery.  You really should have a frank discussion with your surgeon about what he is trying to achieve with the larger size, and especially express to him about your preference to stay the same.  When changing from saline to silicone, that procedure in itself does NOT require a size increase.  

Silicone gel implants not only 'feel' softer then saline, they usually 'look' softer as well. Saline devices tend to project more than silicone gel. For these reasons, a comparable size gel implant often appears smaller than its saline counterpart. Many surgeons will opt to go up slightly in volume to account for these differences when switching from saline to gels. As long as the increase in volume is not great, your cup size should not necessarily change. Some of your firmness may be due to capsular contracture, and it sounds as though your surgeon plans to correct this as well to maintain softness. You've raised a very good question that many patients share. I would discuss your concerns directly with your plastic surgeon.

sixteen years ago, some surgeons (including myself had the habit of overfilling saline implants by 10-50cc to keep them from rippling and sloshing around.This may also contribute to why they are feeling firm. Your saline implants may have a suggested fill of 390cc, but you would need to go back and check your records for how much they are actually filled to. That could be a reason for you to go slightly bigger as silicone implants come prefilled and we cannot overfill or adjust the volume of fill. 

Thank you for the question. Online consultants will not be able to provide you with specific enough advice to be truly helpful. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical.  Generally speaking, patients undergoing revisionary breast surgery should understand that there may be many variables besides breast implant volume that come into play when determining optimal  breast implant selection during revisionary breast surgery.  As you mentioned, adjustment of the breast implant capsules may be necessary; this adjustment may be a factor when it comes to selection of appropriate breast implant size/profile.   Furthermore, there may be a different "look" achieved with the same volume silicone versus saline breast implants. Lots to factors to consider...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. For example, I have found that the use of words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.



Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.



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.  Personally, I find it most beneficial to have a wide range of breast implant types, sizes, and profiles available.







I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with. 

Thanks for the great question. If you are happy with your current size, then you should be able to have a similar size silicone implant placed. Your surgeon may be talking about opening up the capsule around the saline implants. If this is the case, the capsule tends to be very thin and should be able to accommodate a similar sized implant. I would make another appt with the surgeon to make sure they understand that you would like a similar size, not a bigger one! Best of luck!~Dr. Sieber

No, you can keep the same size or almost the same size with gel implants. The gel implants come in a variety of specific sizes, but you can choose one that is close to your current size. Just let your doctor know what you want.

No, there is no need to go larger if you are switching from a saline to silicone implant unless you have firmness if the capsule is removed. Just be aware that they may still be firmer. You may consider making a whole new space to place the silicone implant into.