Saline Breast Implant Reduction

Question

I have Mentor saline implants filled to 375 CC, the procedure done in 2004. I have been quite happy with my breasts and the implants, but lately, as I approach menopause, I'm wishing for somewhat smaller breasts! Can I have, say, 100 or 150 cc of  the saline removed from the implants, or will I need to have complete removal and replacement with smaller implants?

Shahram Salemy, MD, FACS · Answer

Downsizing your breast size is best achieved with new implants, not removing the fluid from the existing ones. In order to give you the best cosmetic appearance, you may also require a breast lift as well to tighten the pocket of the implant. Another option is a lift alone without any implants, but these options are best discussed with your surgeon so that he can discuss with you the pros and cons of each choice. Simply removing saline from your existing implants, however, is not a good choice for all of the reasons already stated.

Larry S. Nichter, MD, MS, FACS · Answer

I would not recommend this as the chance of  old implants rupturing in the near future doesn't warrant the risk of a subsequent operation in the future, plus you will probably need to make your pocket smaller, any warranties that may be in effect are voided, and putting too little saline often causes rippling/waviness and premature rupture. Check out IDEAL implants for saline implants that feel like silicone.

William Bruno, MD · Answer

If you currently have 375cc saline implants and would like to end up with 225-275cc you will definitely need new implants as the implants can only be filled to a certain volume. Ex. your 375 cc implant  can be filled from 350-375, but it can't be deflated all the way down into the 225-275cc range.
Converting from 375cc to 225-275cc could possibly leave you with some excess skin or possibly affect your nipple position. You should be evaluated by a board certified plastic surgeon to determine the need, if any, of a potential breast lift, or to decided if the procedure needs to be staged, i.e. first remove the larger implants then a few months later, after the skin has contracted a bit, replace with smaller implants thus avoiding the additional scars that a lift may require.
Best wishes!

John Diaz, MD · Answer

If you would like to decrease the size of an implant, this will require another surgery.
You may be able to keep the same implant if you only want a small amount removed. For example, 25-50 cc, depending on the implant.
Implants have a range of saline they need inside in order to maintain their shape. If you go below this range, the implant will collapse on itself. This will depend on the implant you have and how much saline was put in during the initial surgery.
Thus, if you want to remove a large amount of saline from the implant, you will need to replace the implant for a smaller one.

Farbod Esmailian, MD · Answer

You can adjust those implants by 50 cc, that is, if they were 325 filled to 375.  This is not a significant reduction.
In general, I recommend a reduction by at least 100 cc to have a noticeable difference.  At times also if you do a significant reduction you may also have to tighten the skin (do a lift-mastopexy).  Good luck.

Armando Soto, MD, FACS · Answer

Hi-
Reducing the volume of your existing implants by a noticeable amount would be likely to lead to visible rippling, and would greatly increase the odds of the implants rupturing quickly, as well as introducing the problems outlined by my colleagues.
Your best bet is to get a good handle on your goals, then meet with your surgeon and describe them to him. It sounds like you'd be best off removing the existing implants and placing smaller ones, with or without a breast re-shaping procedure (lift).
Here's hoping you get exactly what you want!

Brent Moelleken, MD · Answer

Saline implants should generally not be underinflated.  They tend to ripple and fail mechanically if they are underinflated.
Simply replacing a large implant with a smaller one can create a deflated, lopsided breast.  It is not just an issue of placing a smaller implant in the pocket, which will still be much larger than the incoming smaller implant.  If nothing is done to the old pocket, the new implant will simply sit too far down and to the side and the breast will appear deflated.  Therefore, the internal capsule should be tightened as well.  This is a tricky procedure and much more complex than a breast augmentation.  However it is well worth it in the right patient.
Also a consideration for patients contemplating a smaller implant is whether they will require a breast lift at the same time; if the skin is saggy, breasts may appear deflated unless a lift is performed.  There are complexities with this surgery as well, i.e. what is the circulation, was the nipple-areola compromised during previous surgeries (i.e. by a submammary dissection).
Many patients actually consider having their implants removed completely and having a lift.  This is an excellent option for women who still have enough breast tissue.
Revision breast surgery can be very satisfying for patients, but it should be carefully planned with both aesthetic and anatomic concerns in mind.

David Shafer, MD, FACS · Answer

Dawn,
Unfortunately, to reduce the size of your implants, they will need to be replaced.  The implants are not made to modify the fill volume after implantation.  Additionally, each implant as a specific fill volume with a narrow range.  Reducing your volume will take your implant out of that range.
One other consideration when reducing your implant size is the effect on the overlying breast tissue/skin.  The larger implant is supporting the overlying breast tissue.  If you reduce the volume of the implant, then the overlying tissue may develop ptosis (or drooping of the breast).  Your doctor should be able to give you a reasonable expectation of possible results.
Good luck with your surgery!

Raffy Karamanoukian, MD, FACS · Answer

Saline Breast implants are designed to be semi-permanent implantable devices.  They are composed of an outer shell of silicone with an inner fill of normal saline (salt water).  In most cases, the skin and breast parenchyma form a sufficient envelope around the breast to produce an aesthetically pleasing breast shape.
Breast aesthetics is thus a composite of breast volume, nipple position, skin envelope, contour, and symmetry.
Merely reducing the size of an existing implant will thus alter several other important factors in breast aesthetics.  It may alter the skin envelope, total volume, shape, symmetry, and nipple position.  It may also cause premature sagging of the existing breast.
Also, all saline breast implants have minimum fill sizes that are within 10 to 15 % of your existing breast size.  Removing excessive saline may compromise the integrity of the implant.

Steven H. Williams, MD · Answer

Unfortunately unless your implant has a port on it (Mentor's Spectrum implants for example) (which are exceedingly rare in cosmetic cases) there is no way to reduce the volume in the implant without replacing the implant.
In addition, even if there were a way to take fluid out of the implant safely, implants are designed to have a minimum volume in them and removing 100ccs would most certainly bring the volume below that safe level and predispose the implant to rupture.  (Underfilling is a very common cause of implant rupture).
 
I hope this helps.
Steven Williams, MD