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

I currently have sub muscular 390cc HP PIP saline implants. They were placed 16 years ago and I love everything about them except for the firmness so I decided to switch to silicone. I have selected a surgeon that prefers sientra implants and suggests I go slightly larger as he will need to open up the bottom of the pocket somewhat. I really like the size I am now as it allows me to run without any issues. Is it really necessary to go larger when exchanging from saline to silicone?

Doctor Answers 14

Exchange From Saline to Silicone?

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

We frequently see patients who want to upgrade their old saline implants to the new generation highly cohesive gel implants because they dislike the excessively firm feel of their saline implants or they have problems of visible rippling. As a general rule, silicone gel implants will look a little bit smaller than a saline implant of the same volume (number of cc's), so for that reason I will usually suggest that if patients are happy with size of their saline implant that we actually use a slightly larger silicone gel implant (25-50 cc). You will not notice any difference it terms of your ability to run with such a small increase.

Saline implants differ from silicone gel implants in that they tend to project through your tissues more forcefully. For this reason saline implants tend to look "perkier" (particularly if they are overfilled), or less natural, depending on your perspective. So there can be other changes in the overall "look" of the implant even at similar volumes. Still patients really prefer the softer more natural feel of their silicone gel implants and most very much like the potentially more natural appearance.

Do I need to go larger when I switch from a saline to silicone breast implant?

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

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. 

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

PIP implants are not 'hard'

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

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.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

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

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

If you are happy with the current size of your implants, and the appearance and shape of your breasts, then you could exchange your saline implants with silicone implants that are the same size and dimensions. Thank you for sharing your question and concerns. Best wishes. Dr. Gregory Park, San Diego Plastic Surgeon

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 177 reviews

Changing implants

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

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.  

Allen M. Doezie, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 57 reviews

Saline to Silicone

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


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!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Breast implant exchange for silicone #plasticsurgery

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

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.

Exchanging saline implants to silicone gel. Size?

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

Thank you for your question. Generally speaking firmness that has developed over the years indicates capsule contracture and not only is it necessary to remove the implant, but the capsules need to be removed as well.  This would leave the exact same implant appearing to be much smaller although also softer and more natural.  I do agree with your surgeon that going to a slightly larger implant will give you a better result.  If you avoid recurrent capsule contracture formation, you will see a dramatic improvement in the feel size and shape of your breast.  Follow your surgeon's instructions to minimize the risk of recurrent encapsulation during the initial critical 6 to 8 weeks of healing.  The video link above will provide more information on treatment of capsule contracture for you.  Enjoy your results and good luck.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews

Saline to silicone re-augmentation. Do I need to go larger?

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

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.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 20 reviews

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

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

It is quite common for patients with older saline implants to exchange them for the silicone device because for most women the silicone ones have a much more natural feel. But a good saline implant is soft, not firm, unless there is some degree of capsular contracture or the implants are overfilled beyond the manufacturer's specs. If you have a copy of the old operative report you know exactly how many ccs are in your saline implants, otherwise you do not so your surgeon should have several sizes of silicone available at the time of surgery. Also we find the saline to project (push forward) more than the equivalent silicone. For that reason it takes a slightly larger silicone implant to look the same as the old saline to the patient. Trust your surgeon's expertise on this one.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 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.