Needle Deflation of Saline Implants Yesterday. One Month Want to Replace with Small Implants. Surgeon Doesn't Want to Go Small?

Replacing w/ silicone under the muscles. I am a 34A now, a little saggy from the deflation & funny looking for the implant still in there. I really just want to gain some fullness in my breast with an implant, but not be near the 32D (300cc) I was before deflation. Surgeon is disagreeing with me. Wants to use a 280 cc silicone. This is too big I think. Any advise. I want a low profile 220cc same width as the one he is suggesting. He says they will look like pancakes.

Doctor Answers 7

Implant revision with silicone

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Without an exam it is impossible to suggest what would be good for you. I personally do not like the low profile implants because they are like pancakes with poor projection in most cases.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Needle deflation of saline implants, surgeon wants to place large gel implants

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Thank you for your question. I assume that you have a small thin frame with saline implants causing rippling and capsular contractures. The reason to deflate the implants in the first place, is to allow your native tissues to rebound and tighten up. This way you might be able to avoid a breast lift at the time of re-augmentation. The right implant size for you is based on your breast's base diameter, skin envelope elasticity, chest wall asymmetry, etc. This can only be determined via a consultation. Your plastic surgeon might be right, but if you do not have mutual trust now, it is best to seek a second opinion. Good luck.

Implant Selection When Downsizing. What to Choose?

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These types of implant decisions can be difficult as there are number of variables, and sometimes you can't always get exactly what you want.

Your surgeon is probably concerned that a significantly smaller implant will not fill out the skin envelope  and therefore the post-operative appearance may be unsatisfactory. It sounds like you didn't have much breast tissue to start with, therefore it is surprising that your original augment with saline implants was on top of the muscle. Likely this didn't look too great and it probably stretched out the skin quite a bit. So now any downsize will have to rely on a great degree of skin retraction which doesn't always happen. Waiting only one month is not very long. Consider waiting at least three months as it usually takes this long to get significant skin retraction. 

Also silicone gel implants do not look as big as saline for the same volume implant, and if put under the muscle, this well compress the implant further. Additionally if you want to go to a lower profile implant, this will further diminish the ability of the implant to fill out the skin in the way it has been stretched. So the combination of things that you want in a new smaller implant may not be what you can realistically have and still get a result that looks good.

Another choice would be to have a breast lift, but there is a significantly elevated risk of nipple loss in the situation of a previous subglandular implant (on top of muscle). Downsizing in this type of situation can become quite complicated and these issues are all best discussed before having the implants deflated. You might consider getting a second opinion before jumping into your next surgery. 

Concerns about Breast Implant Size when Downsizing Implants?

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To give you a good educated answer requires a great deal more information than you are giving us, usually obtained by a physical exam. I think you need to see another surgeon or two if you aren't happy with the info yoou are getting from your doctor.

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

Concerns about Breast Implant Size when Downsizing Implants?

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There is no way that unlike consultants can provide you with precise advice. You may benefit from in person second opinions from board-certified plastic surgeons in your area. Otherwise, the advice you receive online will be potentially confusing and certainly nonspecific to your precise situation.

Best wishes.

Implant sizing

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There are two issues at play here: size and profile. A low profile implant may create a pancake effect which will not be aesthetically pleasing. You also haven't indicated whether the saline implants were above or below the muscle. If your first implants were above the muscle, then know that going below will have a slightly compressive effect. Also, keep in mind that the post-deflation appearance may be skewing your perspective.

Size is your choice

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Its hard to evaluate without pictures, but you should pick the size you want.  If your surgeon wont do it, than you should find another.  Of course, since you were larger before, you may need a lift if you want to stay small.  Since you have been deflated, you should be able to try on the implant size you want, and get a close idea.  Also, if your surgeon has the Vectra or another 3D imaging system, they can show you how you would look.  In my opinion, the most important thing is to pick the size you want.  This will allow you to have a long term result that will keep you happy.  Happy Thanksgiving!

Michael R. Schwartz, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 34 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.