Implants from 2010 - what should I ask for when speaking with my surgeon about replacements? (Photos)

Question

Hi guys, I had a breast augmentation over 20 years ago. I had saline under the muscle for 450 cc it adds up to be about a DD. Since then, I’ve had four children all have breast fed. I’m looking to replace my implants, it’s just time. when I first had the implants, I had normal swelling, but I actually loved the way sat on my chest. They were really high really &noticeable. After a few months, they started to drop and I wish they would have maintained that swelling. Now that I’m getting them redone, I’m looking for advice on what to ask my plastic surgeon. cannot ask my former surgeon he’s currently in prison And i have no records.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos.  Your upper breast fullness, that you had immediately after your augmentation, is normal, but this settles in the majority of patients as the implant settles down to its correct position, which is just above the fold beneath your breasts.  Your photos show your implant is positioned exactly correctly behind your nipple/areola and trying to shift your implant any higher would make it appear that your nipple/areola are sitting on the bottom portion of your breast instead of at the most maximal projection of your breast, which is where they’re supposed to be.  Saline implants will indicate if they have failed because your body will slowly absorb the salt water leaking from the implant and you will notice the breast getting smaller and you know it’s time to replace it.  If you are not having any decrease in volume of your breast, your saline implants are intact, still functioning as they are designed to do and there is no immediate need for replacement. If you wish to replace them, you again could choose between saline or silicone.

Daniel Barrett, MD · Answer

Dear Reliable983542,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Guray Yesiladali, MD, FEBOPRAS · Answer

Hello, after more than 20 years and four pregnancies, it is very reasonable to consider updating your implants.
The “high and very noticeable” look you liked early on was largely due to postoperative swelling and temporary upper pole fullness. Once implants settle, they assume a more natural position. If you are now looking to recreate a higher and more projected appearance, this requires intentional planning rather than relying on swelling.
When speaking with your surgeon, consider discussing the following points:
• Whether your current breast tissue position requires a lift in addition to implant exchange• Implant profile selection, as higher profile implants can create more upper pole fullness• Pocket revision techniques to control implant position and prevent excessive drop• Whether internal support techniques are needed to maintain a higher sitting implant• The difference between saline and modern silicone implants in terms of feel and projection
After pregnancies and breastfeeding, tissue laxity is common. Simply replacing the implant without addressing skin and tissue support may not recreate the look you are hoping for.
Implant exchange is not just about choosing a new size. It is about reshaping the breast envelope to support the aesthetic you want long term.
Wishing you a thoughtful consultation and a result that feels both refreshed and confidently structured.
Güler Güray Yeşiladalı, MD

Mats Hagstrom, MD (license on probation) · Answer

⸻
After approximately 20 years, breast implants do become more susceptible to wear, and the likelihood of spontaneous rupture gradually increases. Occasionally, rupture can occur after minor trauma or compression (for example, during a mammogram).
One reasonable option &mdash; particularly with saline implants &mdash; is observation until a rupture occurs and then replacement at that time. When a saline implant ruptures, it is obvious because the breast rapidly deflates. Silicone implant rupture is more difficult to detect, which often makes management decisions more complex.
There is also nothing inappropriate about electively replacing the implants now, especially if you are considering a change in size, shape, or implant type. If you are happy with your current appearance and do not notice rippling or implant edges, continuing with saline implants can be a practical long-term approach since they are generally easier to monitor.
There is no universally “correct” implant choice &mdash; different implants simply have different advantages and tradeoffs. A proper evaluation should include a detailed discussion of your goals, preferences, and tolerance for maintenance and monitoring.
While implant exchange is typically a straightforward procedure with a relatively low complication rate &mdash; particularly when the existing result is good &mdash; surgeon selection remains important. I recommend scheduling a few in-person consultations with experienced plastic surgeons in your area to review options and pricing, as fees can vary for revision versus primary augmentation.
An in-person consultation will ultimately provide more useful guidance than online advice alone.
Best regards,Mats Hagstrom, MD

Implants from 2010 - what should I ask for when speaking with my surgeon about replacements? (Photos)

Answers (4)

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