Should I Replace my Saline Implants with Silicone Through Nipples or Under the Breast?

I have saline implants for 7 years, through my nipples, and want to replace them with silicone. But one doctor wants to go under the breast instead of through the nipples. He says it's easier and better that way, and that the silicone won't fit through the nipples Another doctor wants to go through the nipples again. Please advice which way is best. The original way through the nipples or under the breast.

Doctor Answers 22

Implant Exchange, Saline to Silicone from the Previous Incision

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It is very common for women to want to switch their breast implants from saline to silicone. In fact the majority of breast augmentations performed in my practice are silicone implants at this point because they give a much more natural soft feel.

Many women who are very thin and go with larger implants can have rippling or a firm feel and look to their implants. Many of my patients have been switched from saline to silicone to have a more natural appearance or decrease their rippling.

The surgery is very straightforward in comparison to the original breast augmentation. The muscle has already been stretched so patients do not feel the same pressure after their surgery. Patients are typically surprised how easy the recovery is for an implant exchange.

Changing implants through the previous incision is the most common way to perform the procedure. This prevents placing any new scars on the breast. Even if you have very small nipples it is a very straightforward procedure using the Keller funnel so that the silicone implant can easily be placed into the breast pocket from the nipple.

Areolar or Breast Crease Incision? What to do?

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Thank you for this interesting question. To decide which approach may be better, I first carefully examine a patient and ask their preference.   If a patient has a history of breast augmentation through the areola and desires a new set of implants, I usually will re-use the original incision.  However, if the patient desires new implants of a larger size which will be difficult to place through the areola, I will offer placement of the implants through a different incision, such as the breast crease.   

It is important to consider that the risk of capsular contracture is likely greater when larger implants are placed through the areolar incision when the areola is small in size.  This is likely due to the exposure of nipple-associated bacteria to the implant surface.   There is likely less chance of bacterial contamination of a larger implant when placed through a breast crease incision which is of the appropriate length.  Hope this helps!

Breast Implants Replacement Through The Nipple

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I would suspect you are having your implants replaced because of the feel or rippling. The choice of the incision is purely a personal preference of your surgeon. If the implant is large and your areolar incision is small, the using an incision under the breast might be better. If possible I would try to use your old incision unless you have a history of capsular contracture.

Richard Linderman, MD
Indianapolis Plastic Surgeon

Implant replacement thru the nipple or beneath the breast

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As someone who gets referred a lot of revision breast surgery, I'm going to disagree slightly with my colleagues and suggest that revision thru the periareolar incision with gel devices can be significantly more difficult a procedure, particularly with larger devices.  Unless the patient is getting some kind of associated periareolar mastopexy, the precision of the IMF approach (particularly for retropectoral implants) is going to be superior for this and produce less potential step off by having to go thru and replicate the breast tissue disrupted by a periareolar disection.  I've seen a number of wierd contour problems on some of these redo's  from periareolar implants where the breast tissue closure creates an almost uncorrectable ripple or step off  that's made more me more circumspect in accepting a small second scar on the IMF.


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Generally speaking, plastic surgeons always try to make use of pre-existing scars.  However, since a silicone implant is being inserted in this case, if your board - certified plastic surgeon feels that the incision would be too small or is worried about stretching the tissue or decreasing sensation to the nipple, then they may advise to put the scar under the breast.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon

Incision for revision breast augmentation

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As you are aware, there are multiple ways to do a breast augmentation and every surgeon has there preferred approach.  For a revision, it is most aesthetically pleasing to go through the original incision so you do not have two scars on your breast.  As long as your original periareolar incision healed well, I would recommend staying with that approach. I hope this helps in your decision.

Kindest regards,

Neil J. Zemmel

Silicone Incision Point

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I would use the Keller Funnel device and with that you can fit the Silicone implants thought the areola incision if desired or through the armpit incision.

Best Replacement Incision

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There is no one best access incision for every person, and it should be considered individually.  The factors involved to determine which on is best for you are numerous including skin type, breast shape, and your preference among others things.  Additionally, some surgeons, including myself, have reservations about certain places for incisions because of concern for bacterial contamination and capsular contracture. 

In your situation, you already have an incision, and that usually is what most surgeons would use to replace your saline for silicone implants.  Assuming you have had a good result with your saline implants and no capsular contracture, than it would be safe to use the same incision again, assuming it is large enough for silicone gel implants. 

Best of luck to you!

Incision choice for breast augmentation with silicone.

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The decision to use periareolar (around the nipple) incisions for breast augmentation with silicone implants depends on the diameter of the areolas and the size of the implants. Silicone implants require a larger incision in general than saline. This is because the saline implant is placed into the breast, then inflated. I feel that if I can place the implants through the previous scar without making a new incision, that is the better option.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Replacement of silicone implants through nipples or under the breasts

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The decision to replace saline implants with silicone is a common one.  The choice of incision is dependent upon many variable.  The first should be a question of the pre-existing incision.  All attempts should be made not put any additional scars of the body.

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.