Your Questions
Your Questions
Q: Dr. Eppley, I had Mentor saline breast implants placed in 1994 and now one has deflated. I need to find out what my options are to replace them.
A:Having a current saline implant deflation, regardless of when they were placed, leaves you with several options. First, you could simply replace the deflated implant only. With an established pocket (provided the deflation has not gone on for months), a saline implant can easily and painlessly be replaced even under local or IV sedation. While that is the simplest thing to do, most women would understandably be concerned about the other implant deflating soon thereafter. (particularly in your case where they are now 18 years old…beyond what most saline implants would be expected to remain intact) Therefore, the second option would be to replace both implants with new saline implants. Once you have suffered a deflation, however, most women do not want to endure another one and would like implants that at least have a chance to last the rest of your lifetime. With that consideration, the third option would be to replace both old saline implants with new silicone gel (gummy bear) breast implants which will not suffer the problem of deflation. They will have the best chance of lasting the rest of your lifetime. Of course, there is always a fourth option of simply removing both implants and not replacing them at all. For understandable reasons this is rarely done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I havge silicone implants that were originally placed way back in 1986. They have served me well and have felt fairly natural until recently. They now have sgtarted to leak and the right side has become contracted nad harder. I have had two plastic surgery consultation with conflicting opinions on how to replace then not remove them. One recommendation was to use a Sientra silicone implant staying on top of the muscle with a lift. The other surgeon would use a Mentor silicone gel implant, placing it under the chest wall muscle, along with a lift. These two opinions have me confused, what do I do?
A: Your original breast implants have served you well, getting over 25 years of service out of them. That has been a good value but their failure was an eventuality and now you must decide how they are going to be replaced, hopefully lasting another 25 years. If you look closely at those two recommendations, they only substantially differ in whether the new implants are placed above or below the muscle. There is no clear cut answer and plastic surgeons will differ in their opinions on this issue.
When it is a primary breast augmentation, the decision for above or below the muscle is more optional and good results in most patients can be obtained either way…albeit with some minor differences when it comes to silicone implants. But when it comes to replacement surgery in someone with established ruptures which will require total capsulectomies, you are going to be better off going under the muscle. (actually partially under the muscle) This is better for prevention of recurrent capsular contracture and infection of which you are now at higher risk.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think I may have ruptured one of my saline breast implants. I had them placed seven years ago and they have been great since surgery. They look fantastic and they have given me some much more confidence. I was running and slipped and fell on my right side. My right breast ended up bruised for several weeks. Now that the swelling and bruising has gone away, my right breast looks smaller. What should I do now? Will I have to pay for a new breast implant and surgery all over again?
A: Low impact trauma is an unusual cause of shell failure in breast implants but it is possible. If you have noticed a breast size change after such an event, then you should return to your plastic surgeon and have it evaluated. Generally a saline implant failure is easy to detect because breast size will change. Loss of saline volume is the only reason one would have a delayed change in breast size. All breast implants from either manufacturer, either Allergan or Mentor, have lifelong replacement warranties should they need to be replaced due to shell failure. Since you are within 10 years from your original surgery, you will get a new pair of breast implants at no charge and up to $3500 towards the cost of surgery to replace them. So while the bad news is that your breast implant may have failed, you will not suffer a economic hardship to have them replaced.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have 350 cc breast implants placed over the muscle. I have had implants for 25 years, with replacement from silicone to saline fifteen years ago due to rupture. This time the left side has deflated. I was desiring either the option of total explantation or downsizing. I had a consultation with a breast implant specialist that stated he would not downsize me but wanted to go to 425cc and would not downsize due to the compromise in results. He will either increase the size or perform a total explant. I am personally not interested in increasing my size at age 50 whatsoever but am wanting to go towards my baseline look as much as possible because this will be the last time I have implants when they need to be replaced in the future. Is there a way a compromise can be reached for a slightly smaller look? I have read cases where many people have downsized. I realize 350 cc is not large. I could accept the same size if there is no compromise. I don’t expect perfection and I realize that the result would be less than perfect and I can live with that. What is difficult about the idea of total explantation is the bagginess.
A: I would agree that total explantation would be an aesthetically difficult choice due to the resultant loose skin and breast sagging, not to mention the volume loss. While it is always better from an aesthetic outcome (pickup of loose skin) to go bigger in a breast implant exchange in older patients due to the skin expansion of loose skin, if that is not what the patient wants then it is not better. What the plastic surgeon was saying about downsizing was that there will be more skin sag (ptosis) afterwards if one goes smaller. While this is intuitively true, the real question is how significant it would really be at, let’s say, a 300cc implant which is roughly a 15% volume difference. I suspect that it would not cause a significant sagging change. Therefore, I see no reason why you could not go to 300cc or 325cc with a new implant. And you have already stated that you can live with a less than perfect result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have a ruptured implant and am in need of a breast augmentation revision. I have always thought they were a little too large. I’m wanting to downsize 25cc; they are different sizes, 275cc on the left and 250cc on the right. When downsized, I would then have 225 and 250. I’m worried about the 275 to 250 because the diameter is so much different. Is this going to look change the look dramatically?
A: In answer to your question, I would have no concern about such a small implant volume change on the breast look. A change of 25cc in a 250cc implant is only a 10% change in volume and would be less than .5cm in base diameter of the implant. In a 275cc implant that volume changes drops to only 9%, a change that is hardly visible. With either implant, that would likely have a minimalistic change in the outer breast appearance. In the case of saline breast implants, there are a lot of variables in implant selection such as their base size and what they are filled to as well as the projection or profile that they have. Such variables can make a visible external difference and all must be considered. With silicone implants, they are prefilled and their only variable is the different projections. (low, medium, and high) As a general rule, visible changes in the size of the external breast when it comes to a breast implant exchange should be in the percent volume change of 20%. Therefore, if one wants to have a smaller breast size with an existing 250cc implant, the downsized implant should be 200cc.
Dr. Barry Eppley
Indianapolis, Indiana
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.
Dr. Barry Eppley