Saline to Silicone - Do I Need to Go Up in CCs to Have the Same Result?

It's always a good idea to follow the advice of the surgeon who is examining you, talking to you about your goals in keeping with your anatomy, and who knows and has operated on your anatomy, rather than any number of on line doctors. However, sometimes an objective outside point of view is helpful.

As I previously answered in another question from you, 50cc is 3 tablespoons plus 1 teaspoon of additional volume. You will not be able to tell a difference with this degree of increase. I would have to respectfully disagree with my colleagues answering this question, based on your request for "a little bigger" and "more cleavage." Bear in mind that a 275cc saline filled to 300cc will have a slightly narrower base diameter (11.7cm, assuming moderate profile implants) than a 300cc moderate profile silicone gel implant (13.5cm). A 350cc silicone moderate profile implant (Mentor) has a base diameter of 14.2cm, and a 400cc implant (mod profile) has a diameter of 14.5cm. So, more cleavage does not absolutely require more volume, but "a little bigger" does!

If you can't decide based on looking at the volume in a glass of exactly how much 50cc or 100cc adds to each breast's volume, consider a 375cc silicone gel implant to "split the difference." This adds 2 1/2 ounces to each side (less than a quarter of a can of soda). Unless you go to a high profile implant, or develop capsular contracture, you should have a "natural" non-fake look regardless of which of these sizes you choose. I believe 375cc implants are the smallest increase I would recommend, and then only if you really don't want much of a visible increase in size at all. Otherwise, go for the 400cc implants. One other consideration; ask your surgeon if he needs to remove any capsule during your size change. He may say "I don't know till I get there." This is a perfectly reasonable answer, but you can tell him that if he does have to remove any tissue, go with the larger implant, as removal of even 20-30g of capsule will require that volume to be replaced with (slightly) larger implants to achieve your goals! Best wishes!

silicone.



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.


It is very common to for women to want to go larger when changing their
implants form saline to silicone. As a
general rule I typically encourage women to go up a least 100cc if they want to
see a noticeable difference after their exchange. This is especially true when going from
saline to silicone. The silicone implant
is much softer and will not look as large as the saline implant.



The silicone implants allow women to have more choices in
terms of the size they would like to be as they can place a larger implant and
have the fuller look they want without looking overly fake.

I don't think there is much difference in the appearance between the same volume silicone and saline implants. The choice has more to do with the amount of soft tissue coverage. If the breasts are far apart now and you have only skin over your breast bone (sternum) It is not possible to give you cleavage. I agree with your surgeons choice.

To get more cleavage, there are a couple of factors to consider:

1)  would a wider base width implant work better for you,

2)  can the pocket be opened up medially any more,

3)  does the pocket need to be closed up (plicated) laterally

 

It's really not about the CC's, although sometimes it works out that way.  Speak to your surgeon about these concerns.

All the best,

If you are switching from saline to silicone, 50cc difference in volume is going to look the same to you.  I think that you should consider a minimum of 100cc difference, ie: 400cc like you stated.  I would be hesitant if I were your operating surgeon to offer you an exchange with only an increase of 50cc as I feel you would be highly disappointed in the results. The volume of fluid is spread out over the entire implant, and will be such a subtle change if you are increasing only 50cc; even 100cc sometimes can be quite subtle.  And going from saline to silicone, the silicone gel implant is a softer implant, so naturally tends to look a bit smaller than the saline for the same volume size.  If you were unsure, in my practice, I would offer you to have your surgery under a local anesthesia and placing sizers during surgery so you could see for yourself.   I would put a 350 on one side, and a 400 on the other side, and sit you up to see for yourself prior to making the final decision on size.  I would also have a few other sizes available, just in case you wanted bigger!  Good luck!

Much of the final “look” achieved after breast augmentation revision surgery  depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

You definitely need a larger implant when going from saline to silicone.   How much depends on how you look during surgery. Your doctor should use sizers during the procedure to determine the right size for you.

There are two issues here.  First of all, a 50cc increase in size is negligible, and you may not notice much of a change.  To get more cleavage the pocket will have to be enlarged more towards the breast bone and closed off towards the outer chest area.  This may or may not be possible for you, and you should discuss these issues with your surgeon.

Your greatest concern was actually listed last.  Whether cleavage (inside breast fullness) can be achieved is in part dependant on your anatomy and the width of your sternum (breast bone).  It is unreliable to solely base implant decisions on the number of ccs.  It is better to determine the dimensions of any implant and the corresponding measurements of the breast in order to predict the desired result as closely as possible.  You have identified your height as an important factor in determining implant size.  Given your height, if the implant is too large you may achieve an over augmented, disproportionate and undesirable appearance.  I would recommend carefully reviewing your concerns with your board certified plastic surgeon so that he or she understands your concerns and can better assess your anatomy and subsequently plan for your surgery.

While general guidelines can be given over the internet, to fully assess the best size for your body and your postoperative desires, you need to be examined and counseled by a board certified plastic surgeon. Don't get caught up in the number (i.e. 400 cc vs. 350 cc etc).  Discuss exactly what you want your postoperative result to be and  then trust that your board certified plastic surgeon has the knowledge and skill to give you that result.