Replacing Saline with Silicone Under a Local?

I have saline implants and want to replace with silicone, they are three years old, over the muscle and were done to replace 20 year old saline ones. I have little breast tissue and the saline ones do not look or feel real and have some bad rippling. My Dr has agreed to replace them for cost using a local in his office. Is this wise, safe, anything I should ask him or wonder about. I try to find something on the web about it but there inst much information.

Doctor Answers 8

Local: advisable or not

There are really two conflicting issues at play here.

1)  You could certainly have an operation in which the old saline implants were removed and a new silicone implant was placed in the same subglandular implant pocket.  This would be safe to do.

2)  If you have "bad ripples", shouldn't you be considering a switch to a sub-pectoral implant?  This would reduce ripples in the cleavage area and upper part of the breast.  Typically, this would be done with general anesthesia or IV sedation.

Orlando Plastic Surgeon
4.9 out of 5 stars 79 reviews

Replacing the same size saline for silicone implants can be done under local anesthesia


If you are simply replacing your saline implants for silicone and they are the same size then doing so under local anesthesia is very doable.  Once the incision is numbed the remainder of the process is essentially straightforward.  You will feel a weird sensation as the implant is removed and the new is placed but that is all.  Other changes such as significant pocket modification can also be accomplished under local anesthesia but requires some finesse on both the part of the patient and surgeon.


All the best,

Dr Remus Repta 

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

Removing and Replacing Breast Implants under Local Anesthesia?

Thank you for the  Question.

Yes, it is possible to remove/replace breast implants under local anesthesia assuming no breast implant pocket work is necessary. However, given that your major concern is breast implant rippling,  you may want to consider breast re-augmentation in the sub muscular (dual plane) position and/or the use of acellular dermal matrix. In my opinion, these options will improve your chances of correcting the “bad rippling”. These operations are best done under general anesthesia.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Breast re-augmentation under local anesthesia

Yes this can be done, but is this the right operation for you? You are describing "bad rippling" due to the thin tissues. Placing the silicone gel implants in a pocket with minimal tissue coverage will not improve your results. It will set you up for another operation which is not right for you. What I would do, is deflate your implants, and then place silicone gel implants in a submuscular pocket at a later date. It is possible that you might need tissue matrix for coverage and/or fat grafts as well. This might sound radical, but doing the same operation over and over and expecting different results is not realistic. Of course the final plan can be determined only via a consultation/examination. Good luck. 

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

Replacing implants under local anesthetic

It is certainly possible to replace implants under local anesthetic.However not in all cases

Contraindications would be capsular contracture or calcification

Desire for larger implants ,implant malposition and transaxillary incision

If the implants are soft symmetrical and preferably above the muscle I usually replace them under local anesthetic

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Replacement Of Implants Under Local Anesthesia

If the silicone implants are being placed in the same pocket as your current saline implants, this could be done under local.  However, since you have "little breast tissue", you will likely be happier if the implants are placed below the muscle.  This would be more difficult for you under local.  Also make certain the office OR is certified.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Replacing Saline with Silicone Under a Local?

Of course it is possible and quite easy if he is putting the new implant of the same size and into the same over the muscle position. But I think you need to consider a subpectoral placement using a dual plane technique and I would personally not want to do that under local anesthesia. You say "in the office", but make sure that means a certified surgical facility in the office. Otherwise I would not consider that.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Implant exchange under local?

It certainly is possible to do a simple implants exchange into the same pocket under local anesthesia (although adding oral pain med and valium might take of the edge). I am not sure what "in his office" means. If it his certified operating room, it sounds reasonable. Otherwise it may not be safe.

But the problems you are describing, including rippling and small amount of your own tissue, may not be properly corrected by simply switching to silicone. You should discuss with your surgeon whether or not you would benefit by have the implants repositioned to the submuscular, or bi-plane position. Your surgeon might not want to reposition the new imlants without anesthesia support. 

Best wishes

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 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.