Replacing 300/315cc for 485cc Sientra Silicone Gels After 15 Years | 5'0" - 110lb - San Mateo, CA

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I'm 37 years old, mother of 3 children ages 19,...

I'm 37 years old, mother of 3 children ages 19, 13, and 7. 5'0" at 110lb. I had my original implants done in 2000, after having my first child. They have held up really well - very mobile, soft, no activity restrictions, and with great sensation; but after the 2 subsequent pregnancies, I experienced some involution. Also because my skin is very thin, the rippling in the implants is evident to the touch when I lean all the way forward. The implants I currently have are old McGhan Model 68 Moderate Profile Salines with diameter of 11.9cm / projection of 4.1cm. Incisions were in the axilla areas. For the duration that I've had them, I've been VERY HAPPY WITH THEM.
I do feel, however, that replacement will these implants that have reflux valves will be inevitable at some point. I felt that it would be easier to mitigate with a replacement now, rather than wait for a rupture. I also just wanted to go bigger to stretch out the loosened skin and to switch to silicone - as only salines were available for first time breast augs back when I had my originals done.
SO! My goals for my replacements are: size enhancement - lateral, medial, and in projection, softer feel, improved smoothness, and for longevity - as I hope these will take me through for the long haul. That being said - I don't want to have any on sizing regrets in hindsight. I originally wanted to go for the 450cc range. My (WONDERFUL) PS and I discussed many factors in the sizing process... my desired goals, the tissue loss with the removal of my current implants, and also the fact that well over 50% of women with BAs report that they wish they would have gone bigger and that they liked their breasts most when they were swollen. These things considered - he suggested going up a size to the 470cc - 490cc range. Being that I really love the shape of my current McGhan's I went and looked up the dimensions of that size range in the same model that I have now. Then I found the Sientras that most closely matched up in dimensions and ended up deciding on the Sientra Moderate Plus 485s. They have a diameter of 13.6cm and projection of 4.8. This may sound really big for someone of my stature - but I really think it does depend on what your goals are. The next size down would have been 435cc, and I just don't think a 100cc increase in volume would have been enough of an upgrade for me. Plus, I have the utmost confidence in my PS. He does, after all, have +20 years experience! He also did my tummy tuck in 2006 - which AMAZINGLY survived my last pregnancy and returned to its post-op condition very quickly after my son's birth.

Two more days ....

before I say goodbye to my first set of twins!!

Today's the day!!!

Two hours after surgery!!!

I'm almost 2 hours out is the surgery center, home, and SOOOOO HAPPY!!!!!
Removal was easy... After my old implants are all cleaned up, doctor said I can have them at my post op! Ended up going with the planned size of 485cc and they're perfect!! Amazing how they've already taken a rounded shape... Doctor says that because I've already had previous stretching, they won't change much from their current appearance. YESSSSSS!!!!!!!
Anesthesiologist did a fantastic job and I was lucid within minutes. Haven't even taken any pain meds yet.

1 Day Post-Op - Feeling GREAT!!!

Removed the dressing today and found lots of bruising underneath where there is just a bit of soreness to the touch; but the incision sites are looking good! The only time I felt some discomfort was when I first got up out of bed, but that passed quickly and I've been up and active since. My left breast does appear a bit bigger than my right, but as much as I LOOOOVE THE RESULTS that is a total nonissue to me.

I still haven't had the need for a single pain pill. I've been able to cook, do laundry, and wash dishes. The only thing I've had difficulty with is reaching things in high places.

Overall, I CANNOT BELIEVE HOW PAINLESS AND SEAMLESS THIS HAS BEEN!!! Earlier in the week I had prepared with icepacks, pain meds of course, laxatives to help with the side effects of the meds, extra support pillows, etc, etc, etc.... And haven't needed any of the above!

All I can think of right now is: "How can I show a really kind gesture of thanks to Dr. Pertsch for doing me so right - ONCE AGAIN??!!! .... EXPLODING WITH HAPPINESS RIGHT NOW (*)(*)

Links and Screen Shots to Sizing Charts

Here are the charts that really helped me in the decision-making process regarding sizing. The jpeg files will probably be too small to see, so here are the links as well:

Sientra Smooth Round:

McGhan Model 68:

2 Days Post-Op and Feeling Some Pain Now

So today was the first day I've had to take any pain medication. I was prescribed Dilaudid, and it is helping nicely. The first day I just had very mild soreness atop both breasts. Now I'm feeling the pain near the actual incision sites (underneath). It hurt the most acutely today when I bent forward and down to pick up a towel. Also hurts when I switch from laying position to sitting up. So I'm just generally moving slower today, taking the meds, really limiting/restricting myself from any activity around the house, and RESTING UP A LOT.

Aside from that, I just can't wait till I'm finally able to take a shower!! I've been using the hand-held shower head to wash from waist down and the length of my arms to my underarms. But Dr. Pertsch has stressed the importance of keeping the stitches totally dry. I haven't been able to lift my arms overhead for long periods of time, so my sis will be giving me help with washing my hair today. Normally, I'm used to showering twice per day though!!

4 Days Post Op - Tried to Go Back to Work

I work as an elementary school special education teacher and teach Language Arts and Math to small groups (1 to 4 students at a time). Nothing very physical - so I tried to go back to work today. I wouldn't say it would have been impossible to make it through the day, but my mind and body were just not all there. I hadn't taken meds this morning because I thought they would slow me down too much to be effective - but even without them I was just moving and thinking in slow motion. Rather than just in the breast areas, my whole body started to have muscle aches. I took that to mean that I simply need more rest.
So here I am now, back at home, in my PJs, just had a piping hot bowl of pho, and now cuddled up in bed. I took a vicodin for the muscle aches just after eating and may take another if I don't feel more relief soon. Unfortunately, I'm unable to get out of school tonight for my grad studies program. Just have to muscle through that!
Hope you ladies are all having a great Monday! :-)

5 Day Post Op Appointment

I went to my 5-day Post-Op Appointment today to have my stitches removed, and that went very well - only felt a bit of pull on my left side and pain was minimal. Coolest part of the appointment was when my doctor gave me my old, emptied, and sterilized implants. They were 300cc bags which were actually measured as having been filled to 301cc(L) and 313cc(R).

I should have mentioned earlier that my implants (both old and new) were placed under the major pectorals but over the subpecs. Again, Dr. Pertsch said there was very little of my own breast tissue lost in the removal as the old ones were very mobile inside and came out easily. (I probably wouldn't have had much to lose anyway lol.) The upper medial part of my right side does appear more projected than I would like and I really hope this settles down with time. Doctor has encouraged me to start massaging that area down daily. He expects that what I see in about a month's time is "what i get!" For now, I like how my newbies look best when in a laying position. I'm gonna continue to wear the band for a couple of weeks to try to get that upper right area to drop a bit. :-)))))

1 week Post-Op

The bruising is fading. Breasts are feeling softer and more mobile now :-) Scars are thickening, but look good. Loving my side boobs lol
'Hope you're all enjoying the weekend!

3 Weeks Post Op

Just saw Dr. Pertsch today as I accompanied a good friend to her first consult appointment, as she has now been inspired to go for BA as well!!
I got to ask him about the cording that I've developed under my breasts. They showed up at 1 wk post op and are still just kinda hangin' out. They're not really noticeable - only when my arms are in certain positions. He says they will get better on their own and not to worry. I guess it's some type of plebitis of the superficial vein; known as Mondor Cord. I have it on both sides, but it's more pronounced on the right. It's uncomfortable when I reach up high, lay proped up on one elbow, or if I try to lift heavy things. I'm gonna do warm compresses nightly to try to get them to go down faster.
Aside from that, my breasts are looking better as the tops are smoothing out more.
I also had my 38th BDay yesterday, and Loving the super cute VS bra another awesome friend and coworker got for me. Lol

6 weeks Post Op

Hi REALSELFERS!! It's been awhile... I'm now at 6 weeks post op and both breasts have softened up quite a bit. I'm starting to see and the benefits of the switch to silicone gel. The initial ripples are smoothing out, making for a really nice handful of boobie!! The scars have also softened quite a bit and their hardly noticeable at all. Upper poles are fuller than I wanted and hope they settle a bit more with time. So I'm still going bra-less everyday, so as not to hinder more dropping. I love the size, and am anxious to see what they'll look like when I get back in the gym and down to my ideal body fat percentage.
Hope you're all well and have a great Memorial Day weekend! :-)

Suuuuper Late Update | 2 Month Post Op Pix

Hey RealSelfers,

Sorry to have left my review hanging without updates for so long!! But here are some pix I took about 10 weeks after my BA replacement. You can see that the swelling had already pretty much disappeared by then and my implants dropped more as well. This revealed some asymmetries, but this is a total nonissue to me. As far as I'm concerned, my goals too fill in the stretched skin and to great lateral and medial fullness were completed, and I'm still very happy. They have also softened even more and the ripples on the sides have softened to be much less evident to the touch. Although there remains some very slight rippling underneath, where my skin is suuuuper thin - overall the rippling is a world better than it was with my old salines.

From time to time, I see other BA's and kind of wish I would have gone with a higher profile; but most of the time I think what I've got is just perfect for me. Even though Dr. Pertsch and I deliberately exceeded my base width, the Sientra 485cc Mod Plus' seems to have been the right dimensions to help me meet my goals (from 11.9 to 13.6cm in diameter/ from 4.1 to 4.8cm projection). My new bra size is a 32DD and I have gone up in my shirt size from an X-small to a small. For sports bras from Lulu I went up from a size 4 to a 6. And in dresses, I increased from a size 0 to 2. Although the fullness can look a bit matronly in certain outfits, I can rock a hotttt look in others. Also - I'm sooooo happy that it seems like all sensation has returned.

Hope this helps some of you!! All the best and happy healing to you all. XOXOXO

4 Month Post Op Pix

San Francisco Plastic Surgeon

Doctor Pertsch has been my plastic surgeon for 15 years - and I have the utmost confidence and trust in his expertise, professionalism, ethics, excellent judgment, and special attention and talent toward aesthetics and detail. Dr. Pertsch is very open about all risks with every procedure so that you are truly able to make an informed decision. His work has always far exceeded my hopes and expectations. Not only does he achieve beautiful results, but they have proven to last over time, as both my original breast aug and tummy tuck (2000/2006 respectively) have held up amazingly well. My original breast aug survived my last two pregnancies and tummy tuck survived my last - returning to post-op condition very soon after my son's birth. Doctor Pertsch really listens to what your goals are and is painstakingly thorough about how to achieve the best final outcome. He is an exceptional artist at his craft. He is very methodical and calculated in his decision making process, and at the same time Dr. Pertsch has a very caring, disarming, and comforting bedside manner. He is also Harvard trained and Board Certified. If I could give 10 stars for the life-changing results he's given me over the years, I absolutely would.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
4 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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