What Size Breast Implant Replacements Should I Get?

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.

Large Breast Implant Replacements Dr Barry EppleyA: 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