Change Of Implant Size

Revision is often requested to further augment breast size. Like revisional surgery to replace a leaking or deflated implant, this technique may be performed through the original incision, but may be better accomplished using a new incision in the lower breast crease. This is best discussed during the consultation. To insert a larger implant, Dr. Epstein may need to create more space in the pocket to accommodate the new, larger size. This step may reduce the risk of capsular contracture and also support the best position of the breasts on the chest wall once tissues have healed.

There are several scenarios that might lead you to change the size of your implants:

• YOU WANT LARGER IMPLANTS THAN YOU CURRENTLY HAVE. When you had undergone your original breast implant surgery, you were not satisfied with the amount of increase in breast size and wanted to be larger. That said, it is possible that your surgeon used the largest implant at the time of your surgery that was able to fit into your breasts safely, but now that time has passed, and your breasts have relaxed (stretched), there is now more room to replace your implants with larger ones. This is not an uncommon scenario. I find that depending upon the starting size of your initial implants, an increase of 70 – 100 cc can make a significant size difference. In some cases, I do make much more substantial size increases. This all depends upon the desires of the patient, as well as the measurements and tissue characteristics of the breasts.
• YOU NEED TO CHANGE YOUR IMPLANTS ANYWAY FOR A REASON OTHER THAN SIZE. If you are having surgery for capsule contracture where new implants are always placed anyway, change from textured to smooth implants, change in type of implant such as saline to silicone or change of firmness of silicone implant, replacement of a ruptured/deflated implant, you are getting a new pair of implants. Consider changing the size to one that you are more comfortable with if your surgeon agrees for technical reasons – that it will fit inside your breast pocket and will look good. 
• CHANGE IN BODY WEIGHT. You may have gained or lost weight and now your breasts are not in proportion to the rest of your torso. If you have gained weight and now want larger implants to bring your breasts more into harmony with the rest of your torso, it is unlikely that you will require a breast lift. If you have lost weight and want to downsize your implants, there are two considerations. First, the implant pocket may to be too large for the implant. Sometimes, the pocket needs to be partially closed off to allow the implant to sit appropriately underneath the breast without shifting to the side. This is addressed by closing off part of the pocket with sutures, a “capsular flap” which is a section of scar tissue capsule that is elevated and shifted to decrease the size of the pocket and restrict movement of the implant within the pocket. I usually like to reinforce these capsular flaps with a piece of Galaflex mesh which adds strength to the repair and prevents disruption until the Galaflex eventually is absorbed by the body and replaced with a layer of scar tissue, which will maintain the integrity of the repair.

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