I Want to Switch 480cc Saline Implants for 650cc Silicone, Too Big?

Switching to silicone will improve the ripples.  You could also consider adding Alloderm or Strattice, if your tissues are very thin.  If your implants are subglandular, you might consider having the implants placed subpectorally - this will help with ripples in the cleavage area.

In terms of more superior fullness, a breast lift or fat grafting could also be considered.  

As for size - that's more of a personal decision.  But bigger implants are heavier, and eventually, something's got to give. Usually, it's the skin, which stretches out.  

Remember: you don't have to go larger to fix these issues.

You do need to switch from saline to silicone implants to remove the rippling.  However, increasing the fullness, lost during pregnancy and nursing, can be achieved by other means than larger implants.  Often patients will benefit from internal plication of the implant capsule which results in elevating the breast and increasing cleavage. At the same time, the intrinsic breast tissue can be elevated internally as well.  It is possible that 480cc silicone implants and internal mastopexy will give you the added fullness you desire.

Best of Luck,

Gary Horndeski, M.D.

Without pictures or doing a good exam, it can be difficult to answer this question.  Rippling can be a common problem with saline implants, especially someone that has thin tissue.  Also, if the implants were placed in a subglandular position rather than submuscular, more rippling can be visible.  Switching to silicone implants often can correct minimal rippling.  However, if there is more significant rippling, the switch in implant material will not work by itself.  Switching the position of the implants to a submuscular position (if not already there) can help.  Also, using another implant material (acellular dermal matrix) on top of the implant can help augment your own tissue and provide more cover to the implant.  Unfortunately, there will be added cost to that.

Switching to larger implants (especially a jump from 480 cc to 650 cc) can be detrimental especially if rippling is already present.  Already thin tissues will become even more thin from the heaviness of the implants.  Please be careful in switching to such large implants.  Make sure that you are examined by a board-certified plastic surgeon.  Good luck!

The answer is yes!  It is reasonable to exchange the saline for silicone to reduce the rippling.  The heavy implants will stretch your skin over time.

Dr. ES

Hello Is1218,

Of course the doctors recommended that you go bigger - you first told them you wanted to be bigger, right?  Unfortunately, few surgeons are going to tell you 'no', because they're afraid you'll walk out the door and go to a doctor that says 'yes'.  And most women will.  Most surgeons know better, but can't afford to loose the business.

You are tall and thin, and I understand you want more 'umph' in your bra size. The problem is that you are already too thin and small breasted for the 480 cc implants you have now.  Switching to the same size gel implants does not guarantee the elimination of rippling, but switching to larger gel implants will unlikely change your rippling status. Why? The larger implants will expand and further thin your already thin tissues, and even gel implants ripple, sometimes severely.

One possible solution involves placement of acellular dermal matrices (ADM), like Alloderm or Strattice, lining the inside of the implant pockets and forming a barrier between your implants and your skin.  The downside is excessive cost (more expensive than a pair of silicone gel implants) and no guarantee of 'eliminating' rippling.  If this solution sounds like a possibility, you should see a few seasoned surgeons with great reputations in breast implant revision.  Their certification in the ABPS and membership in the ASAPS is, of course, an important requirement.

Best of luck!

Implant size and size selection are typically causes for both patient and physician anxiety.  The goal is to provide for the patient an implant size that meets their expectations.  Going from a 480 cc saline to a 650cc gel implant will add approximately 180 grams to each side.   A gel implant will help with some of the rippling problem that you are experiencing.  The problem is that your soft tissue may not support the added weight.  A photo would be helpful to understand your individual anatomy but if you are tall and thin this implant will tend to be large and look unnatural.   Discuss your goals with your plastic surgeon and understand the implications of your choices.  There are other alternatives than you may consider such as the use of an Acellular Dermal Matirx such as Strattise to support the implant and add additional thickness over the implant to mask the ripples.  

Many individuals will switch from saline breast implants to silicone to improve rippling.  However, keep in mind that this switch may not completely alleviate the problem.  Based on your height (5'8) and weight (115 lbs), it sounds like you are tall and thin which means you probably don't have a lot of body fat.  What this means is that your tissues are probably less able to camouflage the implant (because they are already very thin) which means you may still have rippling even after switching to a silicone implant.  

On the same note, based on the information you have provided, it sounds like a 650cc implant would be too large for your body.  And as many of the surgeons who have responded to your question have already stated, this may actually worsen your rippling problem.  I would definitely consider discussing your options in detail with a board certified plastic surgeon.  Good luck!

Hello,

 

If rippling is a problem switching to silicone gel can help reduce it, but going bigger will probably move you in the other direction. You need to figure out your priorities and get a few opinions first. A lift might be in order.

 

 

 

Best Regards,

John Di Saia MD

Going form 480 to 650 will jsut give you heavier larger breasts with the potential for more problems with earlier relapse, more visiblity, etc..

 As you can imagine, it is hard to give you accurate advice without direct examination and a full evaluation of your goals.

In planning your breast augmentation revisionary procedure it will be very important to communicate your size goals with your surgeon.  in my practice I find the use of goal pictures to be very helpful.   I have found that the use of words such as “natural” or “D cup” etc 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. Placing breast implants on top of the skin ( pre-operative “sizing”) is not necessarily accurate either.


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. 
 

I hope this helps.