Will switching from saline to silicone help with sagging? (Photo)

My current saline implants are 8 years old. I'm also 28 years old, 5'6 and 140 pounds. Over the years, they have begun to sag and I now require a padded bra to achieve any volume. Also, they fall completely to the side under my arm pits when I lay down and I can feel the implant through the skin. Also, my left appears much larger than the right. Will switching to silicone help all of this? I want them to sit high and be able to have high volume.

Doctor Answers 8

Will Switching from Saline to Silicone Help With Sagging?

This is a very common scenario for women with larger smooth surface saline implants. Saline implants are very predisposed to stretching your tissues over time. Smooth surface implants slide around very easily on your chest wall and as they slide back and forth they stretch out the implant pocket or capsule and tend to slide down and outwards over time. Due to the effect of gravity and sometimes the mechanical forces of the muscle, the implant drags your breast downwards or outwards when you lay down. You can feel the implant because it has caused your tissues to thin out over time. This is similar to what happens to any women with large natural breasts over time. This problem can also occur with textured surface implants if proper adherence does not take place.

Simply switching to a silicone implant of similar or larger volume will not solve the problem. In fact, a larger implant will only make it worse. What needs to happen is that the implant needs to be repositioned internally so that it sits higher on your chest wall. Historically this was accomplished either by suturing the internal pocket or capsule (so called capsulorraphy), or by reinforcing the internal pocket with an implantable material such as Strattice or Seri Scaffold. These reinforcing materials are expensive and take time to suture in place which makes for an expensive repair. Many others have suggested that you will also need a breast lift or mastopexy. I do not necessarily agree. You appear to have nice quality skin and it is obvious that your implant is dragging your skin and remaining breast tissue downwards. Often once the weight of the implant is removed, or internally supported, the residual skin elasticity may elevate your breast tissue along with your nipple. Thus you may be able to avoid the scars associated with a breast lift.

Another alternative would be to switch to a textured surface silicone gel implant along with internal suture tightening of the pocket and shrinking the capsule using a procedure called "Popcorn technique". This will create an internal "lift" and if your breast tissue has thinned, it may produce enough internal lift to allow you to avoid a traditional breast lift. The textured surface implant will adhere to your tissues thus helping to maintain your implant in position and avoiding the downward/outward descent of the implant over time. An example of this type of repair is shown in the breast implant revision photo at the top of this page.

Treating this problem by replacing your implant with a large very high profile silicone gel implant on top of the muscle would be a very poor choice. First of all, initially you will look ridiculous. Your tissues are already thin and they would become stretched even thinner by a larger implant. With the implant on top of the muscle this would predispose you to palpable or even visible rippling of your breast. Also a larger implant will only tend to drag your breast downward and outwards over time. You can't repeal the law of gravity with a bigger implant.

Finally, it is possible that you have a partial deflation of your right implant (usually a valve leak). At 8 years you should still be eligible for replacement of the implant under the manufacturers warranty. Often they will allow you to upgrade to a silicone gel implant at a reduced price and they will cover some of the cost of replacement.

Kirkland Plastic Surgeon
4.8 out of 5 stars 53 reviews

Internal bra plus lift for sagging saline implants

Several things to consider:
  • When implants fall too far to the side, that is a sign that the tissues are too weak to support the implant; an internal bra with Strattice or Galaflex will help.
  • The internal bra will also help with rippling whether you go to silicone or stay with saline.
  • The internal bra will also help support the implants for better long-term upper pole fullness.
  • Although it does not appear that the nipple position is very low, a lift will probably be needed to adjust the skin envelope to the breast mound.
  • Larger implants alone will probably make the issue worse not better.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Fight or Switch?

I do not completely agree with my colleagues here.
The answer depends upon several things.
First, has your right side deflated?
The answer depends upon your goals and desires.
If you are adamant that you do not want scars on your breasts, dont mind a large cup size, and can be satisfied with less than perfect, you can consider very high profile large Inspira implants. They will certainly raise your breasts/nipples, especially if your current implants are under the muscle. They would have to be placed on top.
Best wishes

Richard Sadove, MD
Gainesville Plastic Surgeon
4.9 out of 5 stars 22 reviews

Saline to silicone

Even if you change from saline to silicone, you will need a lift. They appear a bit say and increasing the volume will not "lift" the breasts to any significant degree.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Switch from saline to silicone for sagging?

Thank you for including photographs!  Just changing the implants from saline to silicone, even with a substantial size increase, is not likely to help you with the issues that are visible from the photographs and the ones you describe.  In order to achieve more uplifted breasts with upper pole fullness that do not fall to the side when you are laying down, you would need to have a breast lift (mastopexy) and tightening of the capsule around the implant inside.  A change from saline to silicone would also be beneficial because they are less noticeable with touch.  The combination of these procedures should also be able to significantly improve or totally resolve the size difference also.  Best wishes for a beautiful result!

Alyson Wells, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 24 reviews

Silcone versus saline in implant exchange

I have to agree, while silicone implants will feel better (less rippling and palpability) they will not magically lift your breasts.  To get a higher breast is going to require a breast lift.  Meet with a few board certified plastic surgeons and look at their before and after pictures and discuss your options and what is possible. 

Melinda Haws, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 44 reviews

Implant Exchange

Unfortunately, just switching implants from saline to silicone will not help with the issues you are describing.  It really sounds like you are looking for a mastopexy with implant exchange.  This is a breast lift which would lift your breasts to a higher position and remove the excess skin.  Switching to a silicone implant at that time would be good to give you a nicer look and feel as well.
There is a small chance that you may be able to just get a capsule adjustment to help with some of the problems (the falling off to the side) you describe but need to be seen in person to make final determination.
Hope this helps and good luck.

Khashayar Mohebali, MD, FACS
Bay Area Plastic Surgeon
4.9 out of 5 stars 11 reviews

Will switching from saline to silicone help with sagging?

Thank you for the question and pictures. No, exchange of breast implants alone (saline to silicone gel) will not help with "sagging".   Revision breast surgery that will likely be necessary to achieve your described outcome will likely involve adjustment of the breast capsules ( capsulorraphy), selection of the appropriate breast implant size/profile, and possible mastopexy (breast lifting) surgery.  The use of additional supportive material such as acellular dermal matrix may be helpful when it comes to providing additional support and/or improvement of breast implant rippling/palpability.

Best to seek consultation with the board-certified plastic surgeons who can demonstrate significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully as well. Use as many "visual aids" such as goal photographs during the communication process. Working together you will come up with a plan to achieve an outcome that you will be pleased with. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 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.