Your Questions
Your Questions
Q: Dr. Eppley, I am interested in breast implant replacements with or without a breast lift. I have saline implants that are 18 years old. I was a small B and the implants brought me to a small D. I’ve had two children and breast fed without complications. I feel like the implants stayed in place and my breasts didn’t. I don’t really want them this large anymore anyways but I’m unsure if I should take them out and get a lift or get them smaller with a lift. It would partly depend on cost but also on which one will look better. I just want a normal size and breasts that are perky.
A: It is not rare that pregnancy causes the existing breast tissue over implants to sag off of them after becoming enlarged and then deflated. This indicates that some form of a breast lift is absolutely needed, the only question is whether smaller implants are still needed to maintain persistent upper pole fullness of the breasts. A breast lift, while moving the nipple back up and tightening the breast mound around it will not maintain long-term upper pole breast mound fullness. This it is very likely that a small implant may still be needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am having breast implant replacements surgery one week from tomorrow. I am going to send some photos of myself again and the final pic of what I would like to get close to ( yes I know I’ll never be them or anyone else) just looking to getting close to that result. I also realize you told me I’d have to give up silicone and go with saline overfilled. You had me at 655cc Sientra high profile silicone, but if I need to stay with saline to even go in that direction of a result I understand. Also, I understand you won’t be able to use my previous under the breast incision, but the aerola one. The picture I am sending is close to my stats, although I don’t know exact size I know I was an A before I ever got implants too and I don’t know her bwd measurement. Looks like she has 700 silicone ultra high profile, but then again I have the sag that filters in too. Thank you again for your patience! You don’t know how much it is appreciated.
A: Your breast implant replacements choice is a tough one because there is no ideal solution. Each implant size type choice has its own aesthetic tradeoffs. To get a really round look, it is going to take significant volume. Given that you have roughly 350cc implants in place now, you would have to triple that volume to create a very full round look. Only saline implants will allow that volume by taking 700cc/800cc implant and overfilling them to 900cc to 1000cc volumes. (e.g., Allergan high profile round saline 750cc implants) That will pick up all the loose skin and fill it out but to do so will likely make you bigger than the pictures you have shown. Your natural breasts have a bigger base and a lot more loose skin than any of the ideal pictures you are showing. In addition, it is important for you to realize that even at these volumes your breasts are not going to be lifted per se. They are going to stay where they are and just bigger in that position. In conclusion with overfilled saline implants, it is important that you will have to accept a very large round size that sit slower in your chest wall than you desire. The only way to get around the sagging issues is to have a breast lift first and then six months have new implants placed. But because of the scars this is not on the table for consideration.
If we go with silicone breast implant replacements, it would have to be an ultra high profile implant at 700cc or 800cc volume with base widths of 13.5 or 14.2 cms respectively. (Allergan) In so doing you will get the most breast volume that can be achieved with silicone implants. But whether it will give that very round full look that you desire can not really be known until during actual surgery. It is just hard to predict what the skin will do with the volume. I suspect it will take the 800cc to get the best effect possible with this approach. Again, however, this will not lift up the breasts higher in the chest wall.
Regardless of the implant style and volume chosen, the safest approach in very large breast augmentations is with the areolar incision. This deuces the risk of bottoming out of the implants after surgery because it does not place a ‘weak point’ on the underside of the breast where a lower breast fold incision is placed. It is important to realize the stress of the supporting breast tissues that large implants place.
This should give you enough information to pick which implant type (saline or silicone) and their tradeoffs is most important to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 35 year old woman. I have attached some pictures for your reference. I would like you to give me your opinion on what you could do to make my shape more curvy. (widen hips, increase buttock projection and decrease waist, back and arms size) I think liposuction to the abdomen, flanks and back plus re-distribution to the buttock and hip area is certainly something I would like to consider.
As you can see in my pictures I also have had a breast augmentation and have been told that these are polyurethane, so they may be hard to remove. I would like your thoughts on what you may do to make my breasts slightly smaller and less projected, but more natural and rounded.
Could you tell me how long I would need to stay in hospital, then in the area before I fly home ( and details of how soon I can fly) Thanks!
A: Thank you for sending your pictures and providing your body contouring objectives. I believe you are correct in the approach to improving your body shape through a combination of aggressive liposuction of the abdomen, waist, back and arms with redistribution of the fat aspirate to your buttocks. That combined procedure has a name and is the well known Brazilian Butt Lift with assured body contouring benefits from the fat harvest and buttock augmentation from the liposuction ‘discard’.
In regards to your breast implants, these are harder to remove than smooth silicone shell implants but let’s not confuse harder with impossible. Most likely they have some degree of encapsulation which makes them look very ‘stuck on’ and firm due to the encapsulation. Removing the implants and their capsule with a slightly smaller volume implant should make them softer and a little less projected. It would ultimately be helpful to know what the implant volume is when planning their replacements and I would probably drop the volume down by about 50cc.
This type of body contouring surgery is done in my private surgery center, not a hospital, where the costs are much lower. Given that you are from afar, I would keep you overnight but you could go back to the hotel the next day. I would anticipate you flying home within 5 to 7 days after the procedure at most.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast implant replacements. I currently have 400cc saline breast implants in and the plastic surgeon I went to suggested replacing them with 650cc smooth round silicone implants. Based on where I am now and where I want to be (I attached a bunch of ideal breast augmentation results) I do not think he and I are on the same page. I don’t think he understands what I mean when I say extreme breast augmentation. Can you look at all my pictures and tell me what you think. Your reputation as a plastic surgeon precedes you so your opinion would mean a lot to me. Thanks!
A: Thank you for sending all the photos of your breasts and that of your ideal result. Based on how your breasts look now with 400cc implants and their degree of sag and nipple position, none of those ideal results are achievable for your breasts. Your breasts have too much skin and sag to look that high up on the chest or to be that round…regardless of the size implant used. All that can be done is to make them bigger and somewhat more round but getting enough implant volume in place is the key. It is clear to me with these goals that 650cc is not going to adequate. more likely it is somewhere between 800ccs and 1000ccs to be able to fill out your breasts for a rounder fuller look. No silicone implant is made over 800ccs and its weight will make the breasts bigger but not as round as you would like. Only overfilled saline implants will create a more rounder effect as they naturally sit higher and rounder when overfilled. Most likely an 800cc saline implant filled to 960cc to 1000cc will be needed. It would also be important to use an areolar incision when placing such large breast implants to keep the incision at the top of the mound and away from the skin stretching effects as the base of the breast mound. Anytime one gets over 800ccs in implant volume that would fall into the classification of extreme breast augmentation or the use of very large breast implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am sure as people read stories and see photos about breast augmentation results they start to freak out. Everyone on RealSelf is saying there is no projection with the Sientra high profile implant and how many are disappointed. I know a lot of things go into play for each individual. However, since I have the mentor round smooth saline now at 300cc, I’m wanting a FULLER, ROUNDER, BIGGER implant. We had decided on 655cc Sientra high profile silicone. Again I read because of being under the muscle you lose a lot off cc’s there. I don’t wanna be the same size I am now and I’m not looking to just increase one size. Are these actually the “right” implant for the “look” I’m after? I don’t want to be disappointed. I’m just under 3 weeks from surgery. This is the kinda look I’m after now. I’m 5ft, 111lbs and you have my measurement. I just want to be proud and satisfied.
A: Thank you for sharing this pictorial result from another patient’s outcome as it is very helpful to figure out what may be best for you. It is important to point out that you are never going to get that same result no matter breast implants you use because you simply do not have her body or breasts. That is not a realistic result for you on your breast implant exchange. It does, however, provide further insight into what you should do to help get as close that type of result as possible for your breast implant replacements.
First no silicone implant, regardless of manufacturer, can achieve that degree of roundness and upper pole fullness…unless one is 20 years old with tight skin and little to no natural breast tissue. This kind of approximate result can only come from overfilled saline implants. Saline implants create much rounder and fuller breasts because the fill material is under pressure. That is why they can look so round. Size also plays a factor and I would suspect that you would need a base size of a minimum of 650ccs filled to 800ccs (or more) to come close to that look. At the least if you use silicone implants they would have be ultra high profile (like from Allergan) and be close to 750cc to 800ccs in size.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, for my upcoming breast implant replacements surgery for implant replacements I have been researching and reading on the multivitamins to take, which do you recommend? Also, is a surgical bra provided after surgery or will I need to bring one? If I need to bring one how do I know what size to buy? I am going from the 300cc saline to 655 high profile silicone. Also, what do you recommend on scar prevention? My option of what I read is the silicone scar sheets? Also I was reading something about arnica Montana for bruising? So many brands and so many options, I would like to know what my surgeon recommends from experience.
A: Whether it is an initial breast augmentation surgery or for that of breast implant replacements, I see not need for the use of vitamins or other supplements. They provide no documented improvement in healing and I have never used them for breast augmentation surgery.
You will be provided with a surgical bra which is applied at the conclusion of the procedure.
In terms of adverse scar prevention, topical silicone gel or sheets are fine. Sheets are usually the easiest to use as a bra helps hold them in place and also applies pressure to the sheeting which is known to be beneficial for optimal scar appearance when applied early after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thanks for speaking with me last week for my breast implant replacement consultation. I am scheduled for breast implant replacement surgery next month and I have a question. On my pre-op papers, I noticed you are recommending a change from my current round 390 cc moderate profile to high-profile 595-655 cc implant. I am familiar with the moderate profile, but not so much the high. I just wanted to make sure the high profile is not going to be the “round ball” look. I am wanting a more natural look. Could you explain the use of the high profile for me? Again, thank you for you time and for seeing me last Friday. Im looking forward to my procedure.
A: Your question about the profile of your breast implant replacements is a good one and understandably can be confusing. When comparing saline (your current implants) and silicone (your new implants) implants, the projection/profiles between them are not comparable or 1:1. Saline implants naturally sit higher (have more projection) than silicone breast implants because they are under some pressure or distension from the saline. (particularly if they are overfilled) Silicone is softer and not distended because they really are to some degree underfilled for the bag. (this is demonstrated by looking at a silicone implant sitting on the table and it will have an ‘ashtray’ effect while a saline-filled one will be very round and puffy) Thus a moderate saline implant profile is really comparable to a high silicone implant profile.
There is also the issue that as you go bigger in implant size, you do not want the implant to be too wide. Thus a higher profile silicone implant allows for the increased volume but without adding substantial more implant width.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thanks for speaking with me last week for my breast implant replacement consultation. I am scheduled for breast implant replacement surgery next month and I have a question. On my pre-op papers, I noticed you are recommending a change from my current round 390 cc moderate profile to high-profile 595-655 cc implant. I am familiar with the moderate profile, but not so much the high. I just wanted to make sure the high profile is not going to be the “round ball” look. I am wanting a more natural look. Could you explain the use of the high profile for me? Again, thank you for you time and for seeing me last Friday. Im looking forward to my procedure.
A: Your question about the profile of the implants is a good one and understandably can be confusing. When comparing saline (your current implants) and silicone (your new implants) implants, the projection/profiles between them are not comparable or 1:1. Saline implants naturally sit higher (have more projection) than silicone breast implants because they are under some pressure or distortion from the saline. (particularly if they are overfilled) Silicone is softer and not distended because they really are to some degree underfilled for the bag. (this is demonstrated by looking at a silicone implant sitting on the table and it will have an ‘ashtray’ effect while a saline-filled one will be very round and puffy) Thus a moderate saline implant profile is really comparable to a high silicone implant profile.
There is also the issue that as you go bigger in implant size, you do not want the implant to be too wide. Thus a higher profile silicone implant allows for the increased volume but without adding substantial more implant width.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in need of breast implant replacements. I had breast augmentation in 1991 and it appears one of my implants must have ruptured and has deflated. I need to explore my options.The original surgery was done by using implants with a silicone shell with outer saline fluid.
A: Your original breast implants by description were what was known as Becker implants. They were a double lumen ( 2 bags) implant with an inner bag that contained silicone and an outer bag that contained saline fluid that was filled at the time of surgery. The logic of that old style breast implant was that it helped control silicone gel ‘bleed’ which had a known effect of causing high rates of capsular contracture at the time. (breast implant hardening) Those implants have not been manufactured for over 20 years although some few patients still exist with them in. Like a completely saline-filled breast implants, rupture and partial deflation (remember there js still an inner bag that has intact silicone gel) was inevitable. Getting 23 years of service out of these breast implants means you have done well. This day was eventually coming and it now appears that it is here. The only real significant question with breast implant replacements is whether you want to go with a completely saline-filled or silicone gel type breast implant and whether you want a similar size in volume with these replacements.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just turned 60. I had breast implants in 1985, thinking I need to have them removed and put in new ones. How much would that be? Also,wanting to find out about around my eyes, had botox but my skin is thin and I look tired all the time. Is there fillers? Had filler around laugh lines and below my eyes but didn’t work or last. I need help.
A: Thank you for your inquiry. I will assume that since your original breast implants were placed in 1985 that they were silicone and probably were placed above the muscle. The pertinent questions about them now 25 + years later is do they need a total capsulectomy (removal of all surrounding scar tissue), are the existing implants ruptured, and what type of implants (saline vs silicone) do you want to replace them. All of these factors control what needs to be done and the cost to do them. So any information that you can provide me in that regard would be helpful in deriving the cost of surgery.
When it comes to your face, you have already learned that injectable fillers are not going to provide any solution for tired looking eyes at your age. Most likely this is a surgical issue of removing excess skin and fat (blepharoplasty surgery) to really get a substantative change in your eye appearance. I can answer this question more definitively if you can send me some pictures of your eyes.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have had saline breast implants now in place for over 20 years without any problems. My only concern has been the rippling that I feel on the sides of my breasts. I would like to have a more natural feel without the rippling that I understand I will have with the newer silicone gel breast implants. I also want to go to a bigger size. How difficult or complicated is this replacement surgery?
A: Given that you have had no problems for over two decades and have been pleased with the results (minus the rippling) all these years, this indicates well formed pockets. With established pockets that do not need to be adjusted, this would be a simple procedure of swapping a new pair for the olds. The only true surgical site would be the incision and dissection down into the existing capsule. This will result in essentially little to no pain, swelling and bruising after surgery. This will be quite a different experience than your original breast augmentation surgery. It will make no difference that you will be increasing implant size as today’s new implants have more narrow base diameters with increased projection than your old ones. This means that almost regardless of what size you want to go to (within reason), the implant capsule will not need to released or expanded from its existing size to accommodate new implants that are 100 to 150ccs bigger.
Dr. Barry Eppley
Indianapolis, Indiana