600CC Silicone Exchange for 450CC Saline and Lift, is This Large Enough for a E Cup? 5'4'', 113, 40yr Old? (photo)

Question

I got 450 cc Saline implants 12 years ago and recently decided I needed a lift and to exchange my implants to silicone. I am looking for a very large breast size, preferably a E or EE. I have picked the Natrelle 600cc high profile and wonder if this is large enough to receive that result. I have more than adequate breast tissue but would like this to be my last exchange/augment for at least 10 years.

Gerald Minniti, MD, FACS · Answer

Hello,

	Keep in mind that although 600 cc sounds like a big increase, and it really is if you are starting with no implants, but it is only 150 cc more than your current 450's, or a 33% increase. This is probably not an "E" cup, but more importantly it is not a big jump, the kind I think you are wanting.  A more appropriate increase would be 50%, or around 675 cc to 700 cc.  Please keep in mind that this is based on very little information and no direct physical exam, and it is possible that my recommendation would be different with an in person consultation.

	Additionally, there is more information that I would want you to know before going forward with large volume re-augmentation.  Most of it is obvious, but you should know that large implants exert a higher stress load on your tissues, possibly necessitating more frequent revisions to reposition implants/tighten the implant pockets, or to re-line the walls of the pockets with a product like Strattice, to minimize rippling and reinforce the pockets.  These can be expensive surgeries, and you are most likely going to shoulder the burden of the cost, so think of revisions as an expected cost of having extra large implants (anything bigger than 500 cc).  Also know that your first revision surgery will likely occur before 10 years.

	Please be sure that your surgeon is expert in complex revision surgeries, and not just an 'implant surgeon'; this is a very different surgery than your first one, and carries with it more risk, even in the best of hands.  Having said that, implant replacement surgery combined with a breast lift is a common surgery for breast surgery experts, and you're likely to have a great result!

	Best of luck!

Ronald J. Edelson, MD · Answer

Having a breast lift done with large implants can lead to problems down the road such as additional sagging and thinning of the skin.  I personally would not advise going that large. Good luck!

Gary M. Horndeski, MD · Answer

Unfortunately, the photograph does not provided any information about breast ptosis and you have not describe whether your implants are in front or behind the muscle.  From your history, it appears that the weight of 450 cc implants have caused descend requiring a lift.  Adding additional weight will cause more descent and may not last the ten years you desire.  You may benefit from a new technique called Implant Exchange with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant.  Small silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision.  This may be the best alternative for you to achieve the anterior projection desired without using a larger implant that will descend and require revision.

	 

	Best Wishes,

	 

	Gary Horndeski, M.D.

Kenneth Hughes, MD · Answer

I typically recommend 100 cc to 150 cc increase to notice a difference in size, so this may be reasonable.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

	Kenneth Hughes, MD Los Angeles, CA

Curtis Wong, MD · Answer

They do work reliably well and will provide you the information you seek. High profile implants do place more stresses on your tissue so down the road, you could be looking at have a re-do lift and maybe even downsizing. Even though we anticipate great long term results, that is never assured so be cautious in what you are wanting, unless you already have significant droop.

Darryl J. Blinski, MD · Answer

No idea as to size since the action posted photo DOES NOT reveal the appearance of your breasts! Good luck though.//

David Finkle, MD · Answer

The only breast implants available from 1992 to 2006 was saline.  The new silicone implants were introduced in 2006 and have gradually become the implant of choice.  Since the only implants we had for 14 years was saline, a lot of women are now exchanging their saline implants for silicone.  The silicone has a more natural feel and look than the saline, but requires a larger incision to insert the implant because they are pre filled. I perform about 2 exchange procedures a week.

	My experience has been, on exchange procedures, that to see a noticeable change in size you  need to go at least 50% more than the original volume.  If the original volume is 450 cc than I would recommend no implant smaller than 675 cc (450 X 150%).  High profile implants have more projection and less base diameter than moderate profile implants.  If you had moderate profile saline implants before and switch to high profile now, you had better check those measurements closely, you may actually be going SMALLER in size with your base diameter.  If that is your intention, than you are fine, if you are trying to go much bigger (and it sounds like you are) then you will be greatly disappointed!

	Do your research on your old and new implants before doing the exchange.  Sometimes I will deflate the implants before and let the skin settle and than re evaluate the whole process, if a lift is needed, what size, incision choice, etc. A deflation procedure is a 5 minute office visit and can help answer many questions regarding future surgery.

	Good Luck!

Michael C. Edwards, MD, FACS · Answer

It is not uncommon for a woman to want to change to a larger implant with revision surgery. It is important to know that a breast lift alone will make your breasts lifted but typically a bit smaller due to compressing natural breast tissue. The only really good way to show you what you might expect would be to carefully deflate your existing saline implants and allow you to place the implants to be used in a sports bra to be a basic idea of what you might expect. There is now way to guarantee what your cup or bra size will be because of the variability of manufacturers. If your implants are currently above the muscle you may want to consider changing them to partially under the muscle to yield a better upper breast look. This is a lot of information. I hope it is helpful.

	Best of luck to you.

	Dr. Edwards

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