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!