Q: Dr. Eppley, I am interested in very large breast implants. I had 2500cc then had a breast lift and now no implants. I would like to start my breast augmentation journey again. What is the largest that you will overfill? I know all the down falls of overfills but still want them.
A: If I understand your breast surgery history, where once you had overfilled saline implants to 2500cc per side, you now have no implants at all. I assume that you got to 2500cc through a staged series of fills using a base size of 800cc implants. (which are the largest base size saline implants made in the USA) To begin the journey, I would start with 800cc saline implants filled to 1200cc to 1400cc and then increase them 500cc at time every 3 months to get to the final volume. Given that the largest postoperative adjustable saline breast implants are 650cc (with a remote port under the skin which could be done as an office procedure for fill), non-remote port implants would have to be used which would require more of a minor surgical procedure for additional fills which could be done under local anesthesia.
Q: Dr. Eppley, I am wanting to get saline breast implants. I am probably considered and A cup and would like to be around a full C cup. One of my biggest concerns is cost. How much would it cost from start to finish to have breast implants done by you? (Including any pre and post-op appointments). I am hoping I can find a good surgeon that is able to do the procedure in my price range because my husband would be the one paying for it and he takes a lot of convincing 🙂 Thank you!
A: As a good working number for saline breast implants, the cost of $4700 can be used. This includes the before surgery consultation, all surgery costs (implants, anesthesia, operating rom fees, surgeon’s fee) and any after surgery visit up to six months after the procedure. You may use this number in your ‘negotiations’ with your husband. May it work favorably for you in these discussions.
The advantages of saline breast implants are their lower cost, the ability to place them through hidden armpits incisions and the capability to adjust the volume of the implant during surgery for any differences seen in the two breasts as they are enlarged.
Breast augmentation remains a popular body contouring procedure for women. In as little as one hour, a woman can dramatically change her body shape in a very favorable way. Only breast implants can produce such a significant body change in such a short period of time. When it comes to breast implants there are two types currently available, saline -filled and silicone filled. Since 2006, silicone breast implants have returned which are filled with a new cohesive gel formulation that is much better than that used in the past.
Given these two choices, how does one decide which type of breast implant is better for them?
In reality, neither saline or silicone breast implants are perfect. If one was truly better than the other, there would be only one choice not the two that we have. Each type of breast implant is safe (FDA-approved) and has its own unique set of advantages and disadvantages. Both of them will do the job and do what they are intended to do… make the breasts bigger. But there are some differences between them and understanding these differences helps you make the best implant.
Saline breast implants have the advantages of a lower cost and can be placed through a small incision high up in the armpit that is not on the breast. That incision location may be an advantage in the Hispanic woman who may be concerned about any scarring around the breasts. Saline implant disadvantages are that there may be some implant rippling that can be felt on the bottom or sides of the breast and the risk of immediate deflation of the breast should the implant rupture.
Silicone breast implants have the benefits of a slightly more natural feel (no rippling) and the breast will not go flat should the implant rupture. However, they do require an incision in the lower breast crease and have higher implant costs.
Other than these implant differences, everything else about the breast augmentation procedure is the same including recovery time (one week or less) and how long the breasts will be swollen. (two to three weeks)
What is the best type of breast implant for you? I tell patients to make their choice based on which of their disadvantages you can live with the best. Both saline and silicone implants work for breast augmentation…which of their disadvantages is more acceptable to you?
Q: Dr. Eppley, I have saline breast implants in now that are 375cc in size. While my surgeon said they would be perfect, I knew from the beginning they were too normal. (maybe perfect for him but not for me) They are under the muscle and are smooth Mentor saline implants. They were placed through an incision under my armpit as I did not want any breast scars. After having had them for six months, I am more convinced than ever that I want to go bigger. I want to go at least 500cc and maybe 550cc. Can my current implants be removed and replaced by going through the armpit again? I still do not want any scars on my nipples or under my breasts. Should I use saline again or go with silicone implants this time?
A: In terms of a size change, you want to make sure that you are having a breast implant volume change of at least 30%, as that usually the minimum it takes to see a real cup size difference on the outside. That is why a change to 500cc (33% is the least you should go) and 550cc (46%) would be more ideal. You do not want to go through a second surgery and still fall short of your size goal.
Since the incision is an important concern for you, the armpit approach can be re-used and your saline implants exchanged for larger ones. While silicone implants can be placed through an armpit incision, there are some limitations of size. The size you have in now is about the limit for inserting silicone implants using a funnel technique through the armpit. There is no limit of size when it comes to saline breast implants through the armpit.
Q: Dr. Eppley, I had saline breast implants of 375ccs filled to 425ccs last year. They were placed through incision in the lower breast crease and placed under the muscle. While I am happy with the size, I noticed about 6 months ago that I can feel a ridge approximately the size of a quarter to the right of my nipple on my right breast and it’s smooth in the center. What do you think this is? Is it a breast mass or lump or is it something on the implant?
A: What you are likely feeling is the valve of the implant. Saline breast implants are manufactured with an indwelling valve so they can be filled at the time of implantation. During surgery, the flat saline implant has a long tube attached to it at this valve. After the implant is positioned in the breast pocket, it is filled with saline through this long tube. Once filled to the desired volume, this tube is removed from the implant by detaching it from the valve by pulling on it. The valve has an attached cover which then snaps closed over the valve opening. This cover creates a very low profile bump or nipple on the implant’s surface. Usually the valve ends up on the underside of the implant by the way the implant is initially placed in the pocket. But it is possible that an implant can flip or be placed ‘valve up’. In breasts with very thin tissue, the valve may be able to be felt and it would be close to being around the nipple area. It poses no concerns other than being able to be felt.
Q: I am interested in making my existing breast implants bigger. I am unsure as to whether it is better to just add more saline to my existing implants or to get new implants altogether. I currently have Mentor smooth round moderate plus saline implants which are 325cc. I am fairly small being 5’ 3” and weigh 108 lbs. I started out as an A cup and am now a C cup. Would adding 50cc to my implant make enough of a difference?
A: The answer to your question can be partially deduced by analyzing the percent change by ratio assessment. With existing 325cc implants, an additional fill of 50cc will make a 15% change in their volume. This will make a noticeable size difference with your small frame but don’t expect it to make a 1/2 or full cup size difference. Also, further saline fill will make the implants feel a little firmer. Assuming that the base size of your implants was 325cc, an additional 50cc will not make them feel abnormally firm. This is a good approach to enhance what you already have for a little ‘perk-up”. But if you are looking for a significant difference in breast size like a D cup, you will need to redo your breast augmentation with new implants that have a larger base size.
Q: I would love to have breast augmentation before my 21th birthday which is later this spring. My preferred approach would be breast augmentation with an incision through armpit area But I also considering the option of an inframammary incision using Memory gel breast implants. Which do you think would be better for me? Thank you.
A: Breast augmentation poses multiple choices for prospective patients to consider. These options are driven by implant choice which can secondarily control the placement of the necessary incision. Saline breast implants are often placed through a small armpit incision because they are inserted deflated and then inflated once into position. Silicone gel breast implants, unless they are very small, can not be placed through the ampit because they are inserted pre-filled or fully inflated. Thus, they are usually placed through a lower breast crease or inframammary fold incision.
But the incision is not the most important part of the breast augmentation procedure, the implant is. All incisions heal really well and are rarely of any secondary cosmetic consequence. Therefore, it is important to understand fully the differences between saline and silicone gel implants. While both work well and do an equally good job at making a larger breast, there are some important minor differences in them that are relevant in the long-term. This is especially pertinent to you at your young age since you will live to see them. These include such risks as implant deflation (saline) and silent rupture. (silicone) You will be replacing these implants at least once on your long remaining lifetime so understanding these differences is important to you.
Q: I have a strange question for you Dr. Eppley but I am very curious. I am going to get breast augmentation in the near future and am an avid swimmer. My friend told me that it might interfere with me swimming. She said she heard that breast implants will act like floats and slow me down or could weigh me down and make it harder to stay afloat. Is what she is saying true?
A: Your question/concern about the impact of breast implants in the water is neither strange nor new. Women have asked me about that numerous times in my Indianapolis plastic surgery practice. One the one hand, millions of women over the past thirty years have had breast implants and such potential problems have never surfaced or been reported. This would strongly suggest that what your friend is telling you is nothing more than an urban myth.
From a scientific standpoint, the question is one of the buoyancy of breast implants. Depending upon the type of breast implant, the answer differs slightly. Saline implants are neutrally buoyant, meaning that they will neither float nor sink. This makes perfect sense since they are essentially the same density as the water in which they are immersed. The two fluids are only separated by the thin containment shell of the implant. Silicone implants, however, are a little more dense than water and will have a slight sinking effect.But they will not completely sink and essentially float as well. This can be easily demonstrated by placing both type of implants in a sink filled with water.
When placed in the body, however, the buoyancy of breast implants demonstrated by benchtop testing becomes irrelevant. Their impact will be the same as any other enclosed body part. Their only potential impact on swimming is on the aerodynamics of the body shape, which is only relevant if one is an Olympic or competitive swimmer.
Q: Hello, I am in the beginning stages of finding a surgeon for breast implant replacement to suit my needs the best. My previous surgeon has since retired and my breast implants are almost 10yrs old. They are saline and I am now a D cup but was a C cup when they were new. I don’t think the increase is due to weight gain. I think its because they have dropped a bit. What do you recommend in regards to implant replacement.
A: The ‘need’ to replace breast implants occurs either to a desire for some type of further enhancement (size change) or an existing problem with one of both of the implants. When it comes to saline implants, the absolute need to replace them is when one fails or deflates. There is no need to change just because they are getting older. My Indianapolis plastic surgery practice motto has been on this very subject…’if they look and feel fine, then there is never a need to replace a saline breast implant.’
That being said, most saline breast implants will eventually undergo a deflation usually in the 10 to 20 year range after their initial placement.
One of the unrecognized (by patients) phenomenon of breast implants is that they can change position over time. Whether it be weight loss, pregnancy, or a larger size implant, the soft tissue containing them can and often does change. When the soft tissue around the implant changes (stretches or relaxes), the position and shape of the breast may soften and settle. In larger implants, their size and weight may cause the lower breast fold (inframmary crease) to drop. This sounds like what has happened in your case.
While silicone gel breast implants were not available 10 years ago, you should seriously consider converting to them at this point if you are looking for further breast improvements. They will not have rippling and may feel softer and more natural. You would also eliminate the lifelong risk of a spontaneous implant deflation. When replacing the implants, you may also consider repositioning of the lower breast fold back up higher to correct any implant bottoming out that has occurred.
Breast Augmentation continues to be one of the most sought after of all cosmetic procedures. While the idea of making a breast larger is conceptually simple, there are several choices that women have to make. What type of implant (saline vs. silicone), what size implant, what amount of implant projection, and whether to have it placed above or below the muscle are the major decisions. Women are also interested in knowing what the experience was like afterwards. Dr. Eppley discusses breast augmentation in this Doc Chat radio show and interviews several women about their experiences and feelings about having been through the procedure. Listen to this show to hear what actual patients have to say about their breast implants and what the process was like for them!