Your Questions

Q: Dr. Eppley, I am interested in a breast implant exchange. I want to change from Mentor moderate plus silicone breast implants to moderate classic profile silicone implants with the same submuscular placement.(dual plane) I want only Mentor smooth round moderate classic profiles in size 385cc or 405cc. I want the most natural natural results with no upper pole fullness. I currently have Mentor 325cc and It is still not natural enough for me. I don’t want to look like I have breast implants.

A: From a breast implant exchange standpoint, changing the profile from moderate plus to a moderate profile will help a little bit bit I suspect not as much as you would like. The best way to maximally decrease upper pole fullness would be an anatomic or shaped breast implant since the shell is designed to distribute 2/3s of the implant’s volume in the lower pole. But smooth silicone implants offers a slightly lower expense to this aesthetic concern so this is an economic choice. But certainly the breast implant exchange as you have proposed can be done.

The interesting question, regardless of the breast implant profile, is how going up in size may work against the very goal you are trying to achieve…a natural look. i suspect that  lowering the implant profile while simultaneously increasing implant size have you ending up right where you started… too much upper pole fullness.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello! I had a breast augmentation done almost 4 years ago. I had beautiful results overall but the doctor went on a very conservative size (230 cc) due to me being naturally quite thin. I feel like throughout the years after the swelling went down and after I stopped taking birth control and gained 10 lbs, they’ve looked smaller and smaller. In addition my left breast is visibly larger than my right. What are my options for breast implant replacement now? Thanks!

A: The good news is that the breast implant replacement or breast implant exchange (secondary breast augmentation) is a lot easier than the first surgery. The implant pocket is already established so minimal tissue dissection is needed for re-entry and implant replacement. Since your desire is to go bigger, the key is not underestimate the size of the new breast implants that are needed. You should go a minimum of 100cc to 150cc bigger to even see a visible change. (maybe 1 cup bigger) Whether the new implants should be even bigger is a matter of further discussion. The chronic problem with some breast implant exchanges is that one thinks they need less volume that they do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have breast implants but I want to be bigger. I think I may have maybe 300ccs ?? But I want to go bigger like 500 cc’s. My only concern is that I am really thin and weight about 110lbs. However, I think they should go that big . I have had 3 kids nursed and had weighed more. I have a really small frame I don’t want them too big but I want a DD . Right now they don’t look big at all. I think it’s because of weight loss and having children.

A: One of the advantages of having existing breast implants is that you have a reference about size. (volume) As a general rule in breast implant exchange for larger breasts you should always go at least 100 to 125cc bigger to see a cup size difference in most patients. Obviously that number changes based on the body frame of the woman. (smaller frames may be 100ccs, larger frames may be 150 to 200ccs) Based on your description, the size change of 200ccs sounds about right in your case. If 300ccs is not big at all and a DD cup is your goal, then at least 200ccs would be appropriate in my experience for your breast implant exchange.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have severe breast implant rippling. I had saline implants placed ten years ago. They were ok but then I had a baby and now there is severe rippling. I was thin to begin with but now have little breast tissue left. Rippling is bad on top of my breasts, even when standing straight. Recently found a mass of thicker tissue below and slightly off center of my left nipple. It looks a little puffy in the mirror. Ultrasound reveals normal breast tissue, but slight bump on implant below lump. What are my options for improvement of the appearance of my breasts?

A: Between being thin, having had breast implants for a period of time and then having a baby, you have lost most of your breast tissue and the natural rippling of saline implants has become evident. This can become really significant if the implants are above the muscle.With little breast tissue scar tissue around the valve can make it appear as a lump. Significant improvement of the rippling can only be done by changing the implants to silicone, trying to thicken the tissue interface between the skin and the implants by fat injections or allogeneic dermal grafts or both.

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

Q: Dr. Eppley, I had breast implants placed three years ago which were 375ccs. I want to go bigger but am not sure what size implant to go to. Do you think 450ccs would be enough?

A: When one desires to have bigger breasts with indwelling implants, the question of how much bigger is obviously very subjective. But most women are not going to go through the effort and expense of surgery if they did no want to see an appreciable difference, at least being a 1/2 cup to a full cup bigger. One of the common mistakes with breast implant replacements for a size change is to not go big enough. While numbers like 500cc or 550cc can seem daunting, the reality is that represents only a 33% to 45% increase in your current breast size. As a general rule, you have to have at least a 25% to 33% change in volume to ever see much of a difference. Another commonly stated number is that it takes 150cc to make a cup size change, although this would be highly influenced by the size of the woman’s chest and her body frame. So you can see that changing from 375cc to 450cc is not going to make much of a difference when it comes to a breast size change. That will make your current a little fuller but that is about it. For those woman that want just a little change or more perky, a 75cc volume implant change may be adequate. But for most women seeking a breast size change through an implant exchange, it will not have been worth the money to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I got breast implants one year ago an am not happy with the size. They are too big. They are only 175cc but they are just too big for me. In exchanging the implants to something smaller, I am not sure what size implant to change to In reading around online, there is much discussion about the base width diameter of the implant like its the holy grail, even though, interestingly, opinions diverge. Some say stay the same implant diameter and no larger, a bit larger, can be smaller by up to one cm, thin women should have smaller, and on and on…. so no hard-and-fast-rule it seems. But 8.2 cm (diameter of smallest available 100cc implants) to my 10.5/11cm change does seem a lot, if base width diameter is typically a consideration that you guys seem to have strong opinions on. I recognize that results are harder to pin down than one might wish, but why do you think that’s better than 130’s with a 10cm diameter, or 125 mod-plus with a 8.9cm diameter, in my case? Related to that, do you think that a lower diameter will diminish the lateral projection that I do not like? Do you think that a similar or slightly smaller diameter than my current 175’s, even if the ccs are lower, will leave me with the same lateral projection “issue”?

A: When the fear from the initial implant is that is was too big, you want to make sure you don’t repeat the same problem. Given that the initial implants were only 175cc and the lowest selection is 100cc, you want to make sure you never say I didn’t go low enough. Thus choosing 100cc implants eliminates that possible outcome.

Implant base width diameter has merit but its biggest contribution in my opinion is in the initial breast augmentation when it is important to not exceed the natural width of the breast so the implants do not get too far to the sides. Once a pocket is established and the implant replacements are going down in size, that issue does not become that important anymore. For you, however, with a fear of too much projection you need to get the flattest and broadest implant base. possible…spread whatever volume there is over a wide base. But the decrease in based width diameter of a 100cc implant may also help the problem of too much lateral projection as well.

Dr. Barry Eppley

Indianapolis, Indiana

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Q: Dr. Eppley, I got breast implants one year ago an am not happy with the size. They are too big. They are only 175cc but they are just too big for me. In exchanging the implants to something smaller, I am not sure what size implant to change to In reading around online, there is much discussion about the base width diameter of the implant like its the holy grail, even though, interestingly, opinions diverge. Some say stay the same implant diameter and no larger, a bit larger, can be smaller by up to one cm, thin women should have smaller, and on and on…. so no hard-and-fast-rule it seems. But 8.2 cm (diameter of smallest available 100cc implants) to my 10.5/11cm change does seem a lot, if base width diameter is typically a consideration that you guys seem to have strong opinions on. I recognize that results are harder to pin down than one might wish, but why do you think that’s better than 130’s with a 10cm diameter, or 125 mod-plus with a 8.9cm diameter, in my case? Related to that, do you think that a lower diameter will diminish the lateral projection that I do not like? Do you think that a similar or slightly smaller diameter than my current 175’s, even if the ccs are lower, will leave me with the same lateral projection “issue”?
A: When the fear from the initial implant is that is was too big, you want to make sure you don’t repeat the same problem. Given that the initial implants were only 175cc and the lowest selection is 100cc, you want to make sure you never say I didn’t go low enough. Thus choosing 100cc implants eliminates that possible outcome.
Implant base width diameter has merit but its biggest contribution in my opinion is in the initial breast augmentation when it is important to not exceed the natural width of the breast so the implants do not get too far to the sides. Once a pocket is established and the implant replacements are going down in size, that issue does not become that important anymore. For you, however, with a fear of too much projection you need to get the flattest and broadest implant base. possible…spread whatever volume there is over a wide base. But the decrease in based width diameter of a 100cc implant may also help the problem of too much lateral projection as well.
Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, right now I have 250 cc mentor smooth round moderate profile implants. I had the surgery 7 years ago and have been in pain all these years. I am finally able to get a revision and switch over to silicone gel implants. I would like to be a bit larger, but very minimal…where me and my husband can notice, but not so much my co-workers and family. I would like more cleavage and not such a big gap in between my breasts. I am 5’7, 118lbs, and naturally was a 32 AA. I am considering either 350cc or 375cc silicone gel moderate plus implants. What would you advise between the two? Isn’t it different when switching over from saline to silicone gel? Meaning adding 125cc’s going from saline to saline, would be much larger than going from saline to silicone gel. The cc’s are the same of course, but because of the way the gel conforms to the body (and is dense), it appears smaller. –so is adding 125cc’s going from saline to silicone 50% bigger?

A: That size difference, 350cc vs 375cc, is visually irrelevant. Always go with the very slightly larger size when choosing between a 25cc difference in implant choices..Regardless of this size change, you will not get your breasts any closer. That would require a much larger implant size to push the volume in towards the sternum. The volumes of saline and silicone implants are identical per cc and there really is no significant size difference between the two. There may be a slight difference in shape with the same size but that is also affected by the projection of the implant shell so saline and silicone breast implants can look very similar depending on what projection of implant is chosen.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I currently have 300cc cc moderate plus silicone breast implants in place whichi were placed eight years ago. I have decided to go bigger and am going to get 650cccc high profile Mentor silicone breast implants through my old inframmary fold scar. My current implants were originally placed under the muscles with complete muscular coverage. Now that I am getting new implants I have read that most plastic surgeons now put them in a dual plane position instead of completely under the muscle. Do you think this dual plane location is better than what I have now and will it give me better results?

A: Historically breast implants were placed in a completely submuscular location. That technique today is largely passé and has been replaced by the dual plane method. What this means is that only the upper half or so of the implant is covered by muscle while the bottom half sits below it. The dual plane technique has become popular because it produces more natural looking results by not having the implants too high. This has also become necessary because the average size breast implant placed today is larger than that which was placed fifteen to twenty years ago.

This discussion for you, however, is largely irrelevant. When making a more than 100% increase in your breast implant volume, it will not be possible for the implants to remain completely under the muscle…even if you wanted it so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to know your experience with breast augmentation revisions. Is this something that you have done often? I am considering revision from saline to silicone and believe I’d like to go smaller. My previous surgical site for the augmentation was axillary and can this be done again with a revision? Any information you can provide would be greatly appreciated.

A:Any plastic surgeon that performs a substantial number of breast augmentations will perform secondary breast implant surgery, given desires of changes in size later in life, change in breast shape due to pregnancy and weight loss and the eventual failure of most breast implants over a patient’s lifetime. So yes I have done many breast implant exchanges and revisional surgery.

I believe you are asking if your existing saline implants could be replaced with smaller silicone implants through your already present axillary scars. The answer to that question is maybe…and it depends on what size silicone implant needs to be inserted through such a small incision. In days past, I would say it would not be adviseable unless the silicone implants are fairly small (under 350ccs). But with today’s funnel insertion technique, much bigger silicone breasts implants can now be placed through much smaller incisions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had breast augmentation three years and had PIP breast implants placed. Since the scandal about PIP implants has been reported, I am concerned about whether my breast implants are safe to have in my body. I don’t want some inferior low-grade silicone material inside my body. Besides getting the implants out and replaced, I also want to go a little smaller. I currently have 475cc implants in and want to downsize them to 400cc, maybe 375cc. Do you think I will develop any sagginess of my breasts if I do so?

A: The answer to what happens to your breast tissue when implants are downsized is not straightforward. There are numerous factors that can affect what happens when the size of the balloon is deflated somewhat. The most important factors are the elasticity of your breast skin and what it actually looked like before the breast implants were placed. Also, whether the implants are positioned above or below the muscle also plays a role. Given that you are considering an implant downsizing of 75cc to 100cc, or 16% to 21% total implant volume, the overlying breast tissue will lose significant support. Sagging could develop with this implant volume reduction if your breast skin has limited elasticity or you had some loose breast skin previously. This is an issue  to consider when determining what your new breast implant size should be.

Dr.  Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had breast augmentation six months ago and I feel that my implants are way too small. (I got Mentor 275cc silicone moderate plus gel implants placed under the muscle) I thought they were too small from the beginning but my surgeon said I would get used to them and come to feel that they were just the right size. I never have and I wear the same bra size as before surgery. When can I get new implants and what size implant should I get?

A: While some women come to accept the size of their breast implants, whether they are a bit too small or too big, they do not if the size is way off from what they expected. You have given it enough time after your initial surgery to try and accommodate to them and it is obvious that you can not. You can have replacement surgery at any time at this point. The implant size you should have based on your desires is based on information that I do not have such as breast base diameter, what your chest and body looks like and the ‘look’ of your breasts that you visually desire. But when changing out implants for a breast augmentation revision to go to a bigger size, there is one rule that I have learned. Make sure that the new implant volume is at least 30% or more from what you have now. Otherwise it will not create enough of an external visible difference. This means in your case of at least 100cc or 375cc to 400cc implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a breast augmentation done seven years ago. Just last week I had a deflation and went back to my plastic surgeon. I am having both redone due to wanting to go fuller. I was an A cup before first surgery and now a C cup using a 350cc MP saline implant. I want a full D and he suggested a 550cc HP saline implants. I am m looking for a much fuller breast with less sagging. I want to make sure that when I go through this again that I get what I want. Does this size implant sound like enough?

A:  When changing breast implant size to go bigger, you want to make sure that you are getting at least a 30% to 40% increase over your prior implant size. Anything less will likely not be that visible. That means going from a 350cc implant, you need to go at least 150cc  bigger if not more. Thus the 550cc implant size sounds good to me. I have no doubt you will be visibly bigger and rounder. Whether your sagging will be improved to your liking, however, may be a different matter. Getting bigger does not always mean your breasts will be more uplifted, as defined by the nipple getting higher and more centered on the breast mound. Make sure you discuss this with your plastic surgeon beforehand to be certain you may not simultaneously benefit by some form of a nipple (areolar) lift with your breast implant exchange.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Earlier this year I had breast augmentation using 400cc saline implants under the muscle. I really wanted bigger implants above the muscle but my surgeon told me that they would ripple too much and the folds of the implant would be seen when I bent over. I went from a 32A to A DD cup but they don’t look that big at all. I would like to go bigger but still want to look natural. Would I have looked bigger if I had the implants placed above the muscle? If I wanted to go bigger can I have them switched to above the muscle?

A: There are a lot of advantages to having breast implants under the muscle, only one of which is less risk of rippling. Lack of mammographic interference, a less acute transition at the upper pole into the implant, and most importantly, a thicker and more vascularized soft tissue cover. (even if only the upper half of the implant is covered) I think you are confused that there will be some perceptible size difference if the same implant is placed above or below the muscle…there is no appreciable difference. While you certainly can increase the size of your existing implants, I would leave them in the same submuscular location. Being a thin-framed woman I would be cautious about getting too big of an implant that may not have adequate soft tissue support in the long-run. This can result in the breast implants bottoming out, a difficult problem to fix satisfactorily.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I have had breast augmentation with saline implants filled to 450ccs. This gave me a 36 D bra size. I had it done five years ago and have been very happy until recently. I have noticed that my breasts seem to be getting lower and my neck and back is hurting more. I am wondering if you think this is because of their weight? I am considering having them replaced with smaller implants that would take me down to a C cup which I assume is around 3255cc to 350ccs. My question is if I do have them reduced will one cup size smaller help them sit higher and reduce my back pain?

A: Your question is an interesting one but I doubt if your breast implants are a primary culprit of your neck and back pain. Contrary to the perception of many, the most common reason why large breasts cause musculoskeletal pain is because of their severe sagging and not just their weight. In most women with breast implants, the implant makes up a large percent of their breast size and the ‘sagging’ they may get with time is more skin relaxation and not true breast tissue ptosis. While I don’t know what your breasts look like, you would have to have a lot of breast tissue sagging off of the implant to cause these problems. Therefore downsizing your implants, short of complete removal, does not seem like it would prove beneficial for pain relief.

Dr. Barry Eppley

Indianapolis, Indiana

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.

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