Deflated Saline Implants- Exchange to Gel

This 43 year old woman had saline implants placed 18 years ago buy another surgeon. They were sub muscular. She really liked the result but over time noticed some rippling and was reassured that the implants were not leaking. With time and soft tissue stretch, the implant cavity or pocket will enlarge and the implants can become more palpable. Eventually the left implant did deflate and the change was immediately noticeable. She sought Dr. Lyle's help to remove and replace her implant. She did not like the palpability so had decided on replacement with silicone gel implants. She also wanted to go larger. At surgery she was found to have smooth walled saline implants- 240 cc filled to their full capacity of 270 cc. She had exchange to smooth walled Allergan SRM 375 cc devices. Her capsules were almost transparent and flimsy. The left side needed a minor degree of capsulotomy as the capsule had started to shrink around the deflated implant. She was very pleased with the larger breast size and decreased palpability of her implant. Exchanging implants would seem to be a straight forward procedure but it is not. A simple switch out may be performed but often manipulation or removal of the capsule is needed and this changes the pocket dimensions and creates a problem with symmetry. Upsizing is almost always easier while downsizing may require a breast lift or capsular repair . Gel implants are frequently exchanged for salines but leaking is not evident. Monitoring is needed.