Want To Have 20 YO Implants Exchanged for Bigger. Should I Go Over or Under Muscle? Saline or Silicone?

I Have Under the Muscle 330 Cc Implant Sugery 21 Years Ago. I Am Considering getting larger implants possibily 600cc. Should I keep the new implants under the muscle or on top of the mscle. Would saline or silcone be better option for me.

Doctor Answers 8

Answering your questions requires a relationship

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Hi there-

Without a consultation to better understand your goals and situation, and an examination to better understand your body and current starting point, I would not feel comfortable or responsible advising you about so technical a detail.

In general, I would say that you are better off with implants under your muscle over the long term.

I would recommend you have a careful discussion and exam with a surgeon you like and feel you can trust.

If you choose your surgeon properly, the other details will take care of themselves.

Replacement Of Old Breast Implants

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With 20 year-old implants, I can only assume that they are silicone. You may or may not have some degree of capsular contracture of which this scar tissue will need to be removed. This will make your tissues potentially thinner. For these reasons, I would stay with or use silicone implants to decrease potential rippling. A submuscular location is a good choice for secondary implant replacement. While some increase in implant size is not unreasonable, you should be careful about stretching out your breast tissues much further. It is also not wise to try and use implant size to improve breast ptrosis or sagging as this does not work.

Exchange of implants

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Doubling the size of your implants may increase the risk of problems with stretching among the first things.  As for pocket location, it relaly depends upon your anatomy and what type of soft tissue coverage you have now.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Caution in going to larger implants

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There are several things to consider in replacing implants, and no one can give you definitive advice without seeing you personally. With that in mind, here are a few general guidelines: Larger implants will be heavier and more prone to stretching the skin and tissues around the implant, which could lead to sagging and rippling. If there is a scar contracture around the implants, that would need to be removed and this further thins the tissues. Staying under the muscle helps with coverage on the top and inner portions of the bresat but not the bottom our outside, so that doesn't help in terms of implant support. Going over is more likely to look fake especially if larger.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Replacing old breast implants

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I would imagine after having 20yr old implants, your breasts would be low and saggy. Please do not make the mistake of replacing your implants for much larger ones in the hope of a lift. This method simply does not work. In addition, the weight of a much larger implant will stretch out tissues even further-making things much more difficult to correct. It would be very helpful if you could re-submit your inquiry with pics. This would help provide you with the best possible advice. Best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Replacing 20 year old implants

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If your implants are 20 years old they are very likely silicone gel, and you might need the capsule to be removed as chances are your implants have leaked and are quite firm. We would suggest you stay with a silicone gel as better to stay with what you know, and have less ripple risk as your tissues may have thinned. The submuscular pocket is a good choice.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

New implants

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unfortunately there is not enough information here to answer your question. I have no idea what type of implants you have and any issues with the implants or the condition of the overlying tissues

Breast Augmentation Revision?

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Thank you for the question. 

It is difficult to give you good advice without direct physical examination or viewing photographs.

Generally, I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants replaced in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

In regards to type of breast implant: 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.

I hope this helps.

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.