I rarely suggest that a patient goes larger than 400 cc, especially if sagging and stretching is a concern of the patient. The weight of the implant can stretch the skin. I think that saline implants are perfectly fine, and you can keep the ones you have if you are not looking to spend more money on implants if you get a revision. The appearance of your breasts 8 months-1 year post-op should be much better and allow you to properly evaluate whether or not your final result is acceptable. Just remember- time will tell.
Saline, silicone, and revisions.
Switching from a saline to a silicone implant in the 480cc range will not make much of a weight difference. Silicone is slightly lighter but not enough to make a difference. Implants over 400cc are considered "large" implants. Your breast skin has already shown that it does not have the elasticity to maintain shape over the long term. Thus, you are likely to have continued sagging and stretching of the breasts regardless of implant type. The real question is whether you are happy with your results? If you were not unhappy with the saline implants prior to the second consultation, keep them! A skin revision is usually a fairly straightforward procedure and can often be done under local anesthesia in the office.
Lollipop lift plus saline implants now needs revision--silicone better?
I'm sorry to hear that you are now considering revision, but IMHO, that is a common complaint with lollipop lifts--they are so appealing to patients (and surgeons) who are happy about no crease incision (or the time/cost to close). The problem is that excising skin in only one dimension, and ignoring the other, leaves excess skin in the crease-to-nipple dimension, which is why the horizontal crease crescent skin excision is needed. So you end up not only with the scar you tried to avoid, but a whole re-do operation! And a revision result that may not be as good as the one you might have achieved with skin tightening in two dimensions instead of just one.
A full Wise-pattern lift would have been a better choice in the first place, and may have avoided the present concerns regarding residual excess skin. Not to mention all that money you saved with a lollipop lift instead of the full lift. How much is that re-do going to cost? Time off. Lost vacation or sick leave. Additional (minimal) risk. More healing.
If you had come to me for a second opinion, in addition to my disagreement with the technique chosen, I too would have recommended silicone to avoid rippling, deflation, and re-operation to place another implant if one of your saline implants eventually leaked or deflated. And no, with silicone implants you don't need MRI scans every 2-3 years to check for "leak." The latest generation of cohesive silicone gel implants by any of the 3 USA implant manufacturers CANNOT leak, and are so durable that rupture is extraordinarily unlikely, despite occasional comments/"statistics" to the contrary.
However, the weight difference between saline and silicone is negligible, and not a factor here. 480cc saline implants weigh almost exactly the same as 480cc silicone implants. Skin sagging and stretching is to be expected with either type of implant over time and aging. You simply want to avoid yet a third operation down the line, which is why you ask these very reasonable questions.
Now, to be fair, all of this is surgeon and patient personal choice, and your surgeon did nothing "WRONG." Many of us would simply have done something different, for the above reasons. You now have to undergo the cost and effort of another operation. My recommendation: get the right procedure and better implants. For one of my patients who had a similar sad story such as yours, please click on the web reference link below. Best wishes! Dr. Tholen
It's not unusual for women to develop recurrent breast sag following the combination of breast augmentation and breast lift surgery. This recurrent sag is related to a variety of factors including the patient's biologic tendencies, sub-glandular placement and excessively large implants.
The type of implant utilized is not considered to be a major contributor to recurrent breast sag. Saline and silicone implants generally have similar weights.
In your particular case, your recurrent sag is probably related to your implant size and biologic tendencies. Under these circumstances, it's important to discuss this issue with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.
Although saline implants may stretch you out a bit more than silicone implants due to the "hammer effect," I don't believe that is playing a role with you. Your post operative results show a rounded upper pole, which suggests that your implants are not stretching your breasts or bottoming out, despite the fact that your arms are elevated in the photos. If your implants were responsible for stretching your breasts, you would have very little upper pole fullness, not to mention upper pole convexity.
The excess tissue in the lower part of the breast is due to inadequate lower pole excision. This is not because you did not have a horizontal incision. Lower pole breast tissue can be excised without a horizontal incision. I, also, disagree that implants above 400 cc's should not be used. That may be true for surgeons that rely on the skin to lift the breast, but is not true if the lift is performed internally using the fascial framework of the breast. Using the fascial framework produces a more durable lift with the ability to avoid a horizontal incision.
Ary Krau MD FACS
When to Switch to Silicone from Saline
Although Silicone is slightly lighter than saline, it is not enough of a difference to be of major concern and doubtful that it will stretch your skin more. If you are happy with your results then there is no need to do anything more than enjoy your result. If not and a minor revision is needed but not related to the implants then I would keep them and save some money
Should I have gone with silicone implants instead of saline?
I do not believe the difference between a silicone or saline implant contributed to the sagging you have after your breast lift with augmentation. However there is more risk of visible rippling with saline implants which is why most plastic surgeons prefer the new cohesive gel silicone breast implants.
Should I have gone with silicone implants instead of saline?
I am not an advocate of the so called " lolipop" lift. Based on your pre-op photos- I would have recommended a full lift with the standard inverted "T" incision. I prefer gel silicone Natrelle implants. It's important to state that these two procedures--- lift and simultaneous implant placement work against each other. Ideally, the lift should be done by itself--- minimum of 3 months allow to elapse and then implant placement. This staging allows the best lift-- and the best volume. I will do both at the same time provided the patient understands the compromise.
The weight difference between saline and silicone is negligible and not the cause of your pseudo-ptosis. The size and weight of the implants alone, saline or silicone, will cause the skin to stretch, resulting in the need for this revision.
A lift that falls short of a desirable result can be caused by several things, but the difference in weight between saline and silicone gel implants is not one of them. If there is no problem with the implants or pockets, there wouild seem to be no reason to change. Fix the lift and leave the implants.