Breast Implant Revision

Q: Dr. Eppley, I am interested in breast implant revision. I had 375cc filled to 425cc saline over the muscle implants placed 20 years ago. I got them after the birth of my first child. I went on to have 4 more children and breastfed all of them. I am 5’4″ and 130 pounds. I feel best at 110 pounds but the rippling of the saline implants is terrible and embarrassing at that weight. I would really like to lose weight, deal with the rippling and switch to silicone implants. Was hoping to increase size to 525-625 if possible. I am worried about animation deformity with under the muscle. I do not like that possibility at all. Can it be avoided? The doctor’s here are very conservative size wise and the ones I have consulted with do not like or offer silicone. They did say switching from over to under would be an very easy procedure but I would like to avoid saline implants. One Dr  from several states away recommended fully under muscle implants. Didn’t even know that was possible. Another recommend acellular matrix grafts with silicone under muscle to minimize but not eliminate any visible movement. Have heard great things about your work and would really appreciate you opinion and ideas on what can be done.

A: Thank you for your inquiry. Let me help clarify all of the breast implant revision options you have presented as they cover every single onethat is available. First of all, the shape of your breast mounds and position of your nipple-areolar complexes are extraordinarily good for someone who had had four children and breastfed them after the original breast augmentation procedure. It is very rare to find someone with your history that does not need a major breast lift at this point. So the approach of simply changing breast implants is a viable one for you.

There is no question that you want to switch to silicone implants. I am shocked to hear that in your area they don’t use silicone breast implants. In contemporary breast implant surgery saline implants today make up less than 25% of implants used and are only used because of their lower costs. They are are inferior implant in regards to feel and longevity compared to silicone implants. While silicone implants will not completely eliminate all rippling, they will go a long way to eliminating the majority of these palpable and visible implant folds.

The next issue is that of either keeping your existing implant location or switching to an under the muscle location. You have essentially decided that already in that any under muscle location will cause an animation deformity. That is an unavoidable issue since most submuscular positions are really partially under the muscle and the side of the implant is only right under the skin. Thus when the pectoralis muscle moves the implant is ‘unchecked’ at the side and it moves in that direction. Maneuvers such as placing ADM grafts to totally cover the implant edge or moving muscle from the side of the chest wall up over the implant can be done to reduce/eliminate that problem. However, increasing the implant size to 600cc makes making a complete submuscular pocket impossible. (implants are too big to get full muscular coverage) The use of ADM grafts is an option for coverage but that will add over $6500 to the cost of surgery for implant cost and time of placement, exponentially increasing the cost of breast implant revision surgery.

I see no problem with switching your existing implant size to 600cc plus, but as you can see you can not have everything that you want. (no animation deformity, no visible rippling, reasonable costs) Thus what I see as the most acceptable option for you to go with a high profile, round smooth silicone implant that remains in your current subglandular position. I prefer the submuscular position almost always and the animation deformity may not be that significant but that may not be risk that is appealing to you

Dr. Barry Eppley

Indianapolis, Indiana