Implant Exchange in 5 days & Concerned Making Wrong Decision! Switching saline to silicone smooth/round & Add appx 100cc (Photo)

Scheduled w/BCPS. In 1st visit he mentioned bottoming out but made it sound like no big deal to address. I'd like to add a cup size too. In a previous question posted here the majority response was that larger implants are a mistake. This concern was not expressed by my surgeon. He said that he prob won't decrease pocket size bc the larger implant will fill the space so it may not be necessary to 'tack it up' and that doing so can sometimes cause an undesirable fold in the breast. Do you agree??

Doctor Answers 12

Bottomed out breasts

Switching to silicone makes sense if you don't like the feel of the saline.  Going larger will be a mistake in the long run,  initially, they may give you the upper fullness you are seeking, but the additional weight will cause the bottoming out to become a worse problem in the future.

San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Implant Exchange with Mini Ultimate Breast Lift(TM)

Your implants are not the problem, the position of them is. Your breasts are ptotic and have bottomed out. Larger implants will only make the problem worse. You need a simultaneous lift and I recommend a new technique called Breast Augmentation with Mini Ultimate Breast LiftTM. 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 round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Adding volume to bottomed out implants

I think that simply changing implant types and adding volume to your breasts is a recipe for disaster and you should be nervous about this plan for your breast revision. You have a very thin breast skin envelope that already is showing signs of not being able to hold the volume of your implants. Adding more volume might improve the shape for a very short amount of time, but will look even worse shortly thereafter. At minimum, you need an implant pocket revision with a capsulorrhaphy to add some support to your breast implants that is not just your skin. And you might need a formal mastoepxy with a vertical component to have long lasting results.

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 84 reviews

What do you want?

Your photos show bottoming out and stretched out tissues... larger implants will not help with that.  Gel implants will ripple less (but not eliminate it) and change temperatures slowly as you are thin.  A lift would be mandatory, with preference for overlapping your inferior skin flaps over simply plication.  But you are now 2 days prior... what does your surgeon say after getting the views from the peanut gallery?

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


Thank you for the pictures.

I don't recommend a larger implant, this will just bring you skin laxity.

Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 253 reviews

Breast Revision: A Larger Implant is Not Always the Best Option

Saline implants are notorious for stretching the lower pole of breasts with time.  This causes the "bottoming out" to occur.  Your implants are sitting too low and also lateral.  Placing a larger implant without addressing the pocket or performing a breast lift, is not recommended.  I usually recommend a breast lift, silicone implants, and pocket revision, possible a capsulorraphy to provide lateral support for the implants so you will have nice cleavage.  You may seek a second opinion prior to undergoing revision.
If you have further questions, feel free to e-mail or call my office.
Thank you.

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 51 reviews

Larger Implant is Not the Answer

Thanks for the pictures.  I would not recommend a larger implant. You will have problems later.  I would recommend downsizing your implants and a lift to give you better shape to your breasts

Dr. ES

Implant Exchange in 5 days & Concerned Making Wrong Decision! Switching saline to silicone smooth/round & Add appx 100cc

You might consider a lifting operation and inferior pocket repair with ACDM sheets. But only in person evaluations allow a more definitive diagnosis. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Implant Exchange in 5 days & Concerned Making Wrong Decision! Switching saline to silicone smooth/round & Add appx 100cc

You definitely have bottoming out of your implants, and I agree with Dr.Pousti that placing larger implants will only give you larger implants that are still bottomed out.  Over time, with the weight of a larger implant, you take the risk of them bottoming out even more.  If you have the implant pocket corrected via caspulorraphy with or without an acellular dermal matrix during your upcoming surgery, you should be very careful to wear a good support bra 24/7 for several weeks to help prevent the correction from coming apart.  I agree that you should schedule another visit with your doctor before surgery to discuss everything again.  I have not seen a problem with an "undesirable fold" in the breast, so not sure what you are referring to.  Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 107 reviews

Would not advise just replacing the implants

As always, a consultation and physical examination in person is crucial to making a decision.  However from looking at your photos i would
be concerned that simply going larger can lead to bottoming out once again (what's to keep LARGER implants from doing the same thing?).  Strong consideration needs to be given to reinforcing the fold at the base of the breast with a capsular repair and possibly even removing some skin at the lower fold to make sure the implant is supported and held up higher on the chest.  This approach is more technically demanding, but more likely to provide a long-lasting stable result.

Denton Watumull, MD
Richardson Plastic Surgeon
5.0 out of 5 stars 21 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.