How Big is Too Big?

I've read several surgeon's comment on this site that implants that are too large will cause problems down the line. What I am curious about is if there is a consensus on what constitute "too large?" Does it depend on a woman's anatomy or is there a certain threshold that will be problematic no matter what? One surgeon said it was implants over 375cc, do you agree?

Doctor Answers (10)

How Big is Big in Breast Augmentation?

+3

Regarding :  "How Big is Too Big?
I've read several surgeon's comment on this site that implants that are too large will cause problems down the line. What I am curious about is if there is a consensus on what constitute "too large?" Does it depend on a woman's anatomy or is there a certain threshold that will be problematic no matter what? One surgeon said it was implants over 375cc, do you agree
?"

Your question is perfectly reasonable. Unfortunately, there is NO accepted consensus on the threshold of which implants may be "too big" EXCEPT to give you a few things to look for>

Skin is a lousy construction material. It is easily damaged by sun exposure. It thins with age and certain life habits and diseases and it stretches when pulled on. When the stretch is rapid the blood flow in the skin stops, the skin becomes white and then it dies and an ulcer forms. (As a result
- The breast skin of a flat, A- breasted woman who never had children is limited in surface area and May NOT physically accommodate the D implant look some of these women ask for. Under such PHYSICAL volumetric limitations, some implants are indeed "too big" to be used.

- In the SAME woman who had children, her breast skin is more pliable and MAY allow the placement of a large breast implant. BUT - in these women, the breast implants may equally be "too big", not because of a physical impossibility of placement but because such women lack enough breast tissue to cover the implants. Without an adequate breast implant coverage, the ripples and folds of the implant are both seen and felt AND the implants cause further stretching and thinning of the breast skin causing irreversible breast changes requiring revision operations of increasing complexity.

Studies, especially by Dr. J. Tebbetts in Dallas and others, have demonstrated that 375cc implants ARE in many cases a useful landmark. Is it accurate in all cases? No. But - The thinner the woman, the less the breast tissue and breast skin available, the WISER it would be to stay below the 375cc landmark if you want to have better and longer lasting Breast Augmentation results.

Dr. Peter Aldea
 


Memphis Plastic Surgeon
5.0 out of 5 stars 62 reviews

Selection of Implants

+2

I consider two factors when selecting implants for my patients:

1.Dimensional planning

2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. Even your fitness levels and other relevant criteria are taken into consideration. It is you who will decide what you are comfortable with.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for.

This way your preferences are known and we can then pick a range of implants that will “fit” just right to give a soft natural fuller look.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 123 reviews

Breast implant size, what is too big

+2

This is a difficult question to answer but there are a few studies to suggest that implants over 400cc's are associated with more complications.  This does not mean you should not have an implant over that size because there are many variables that need to be considered (skin quality, breast tissue, body habitus).  You need to examine several implants and review the sizes in detail with your board certified plastic surgeon prior to insertion. I use a 3D imaging device in my practice which simulates what a specific implant will look like on a patient's body-this is very helpful.

Best wishes,

Dr.Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 150 reviews

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Breast Implants- How big is too big?

+2

Choosing the right implant for your anatomy is not too difficult.  That is, until we take into account the psychology of the whole 'size thing'.  A woman's underlying anatomy is the most important factor in choosing the breast implant size.  With proper measurement and the correct operative plan, safe. effective, long lasting results can be achieved.  So what's the problem?  Many women ignore the advice of their surgeon and choose implants that are too large for their bodies, outside this optimal range.  That results in problems with stretched out tissues, rippling, and un-natural results.  For any given woman, there are only a few optimal sizes available that will give good, long lasting, problem free results.  Choosing implants outside that range results in late complications and overall bad results.   I have been promoting Opti-Sizing for many years, and patients treated in this manner have good, long lasting results.   On the flip side,  I have sometimes seen patients who have gone elsewhere to get the size that they really wanted, then asking for help in correcting the deformities that resulted from this poor choice.  Unfortunately, once you have gone outside the optimal range, it is difficult to fix things- in many ways, it is a one way door, and once you have gone through it, it is difficult if not impossible to get back to square one.  Listen carefully to your surgeon, and make sure you understand the consequences of your decisions before you do this operation. Remember that everything in breast augmentation is about trade offs- you give up something to gain something else.  Have a clear idea about what is most important for you before you see your surgeon.  

Claudio DeLorenzi MD FRCS

Claudio DeLorenzi, MD
Toronto Plastic Surgeon
4.0 out of 5 stars 6 reviews

Implant size is relative, not absolute

+2

Dear Pfab,

When plastic surgeons say that implants are too large, it means that they are too large relative to the patient. The important factors are height, weight, chest width, native breast width, amount of breast tissue, and skin quality. Having implants that are too large has implications on aesthetics and function.

Aesthetics:

  1. a large implant may be too wide for the chest; usually they shouldn't go beyond width of the natural chest wall or else it looks disproportionate
  2. a large implant may be too tall for the chest; when this happens they look like they are sitting up too high
  3. stretch marks can occur if the change in breast size from before to after augmentation is significant
  4. breast veins may be more visible
  5. rippling is more common when a large implant is used
  6. drooping will occur earlier because of gravity's effects

Functional

  1. larger breast implants are heavier, which can cause problems with neck, back, and shoulder discomfort (that is why women with large breasts get breast reductions)
  2. Clothing may be more difficult to find
  3. exercise may be more difficult
  4. heaviness may actually cause chest discomfort

Bottom line: Implant size is relative. A 400cc implant will have different aesthetic and functional effects on someone who is 6' tall vs someone who is 4"10'.  Most surgeons can agree when an implant is CLEARLY too large, but there isn't an absolute dividing line between 'too large' and 'not too large'. Your  experienced board certified plastic surgeon should be able to give you good advice on your personal situation.  Good luck.

Best regards,

Lawrence Tong MD FACS FRCSC

Lawrence Tong, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 18 reviews

How big is too big when discussing breast augmentation?

+1

Keep in mind, when a woman undergoes a breast augmentation, she will be carrying two fluid or gel filled implants on her chest. This fluid or gel has weight. The bigger the implants, the more weight to carry. Additionally, the more stretch to the skin that will result. And don't forget, the heavier the breast, the more susceptible it is to GRAVITY!

Breast reduction is a popular surgery undertaken by women with naturally large breasts. Common symptoms they describe include back pain, shoulder pain, neck pain, sagging breasts, difficulty exercising, and more. These symptoms could develop in a woman who has undergone breast augmentation accordingly. 

After breast augmentation surgery, it is important to wear the proper size bra AND the proper type bra for the activity you are doing. Don't wear a sexy bra if you are going jogging... wear a functional, supportive sports bra...

Also, always wear a bra when you sleep. Gravity doesn't go away just because you are horizontal!

William A. Wallace, MD, FACS
Jacksonville Plastic Surgeon
5.0 out of 5 stars 19 reviews

How big is "too big"

+1

When I examine a woman for implants, I use rely on measurements of the breasts to determine what is the ideal size implant. There is no upper limit, as long as a woman has breast and tissue dimensions that support the use of a larger implant. In reality, it is rare for me to ever go above 500 cc and that size in women with the largest of tissue envelopes. My average implant size is about 300 cc. If you place an implant in the breast larger than what comfortably fits, then you substantially increase the risks of creating deformities, some of them uncorrectable and damaging the breast tissues themselves, along with obtaining less than natural results. You also won't achieve a 24 hr recovery and a minimal revision rate.

Mark D. Epstein, MD
Stony Brook Plastic Surgeon
5.0 out of 5 stars 155 reviews

Selection of breast implants: when is big TOO BIG

+1

Thiere is not absolute when it comes to implant size. Yest there have been studies to suggest that implants cuase increasing problems as they get larger. I have read that implants over 350, for example, have a higher incidence of loss of niipple sensation. But placing a 350cc implant in a 4'11' 90 lb individual is just not the same as putting this into a 5'11' 250 pound individual. EAch case must be treated accordingly and among these, breast diameter is one of the more important measurements. However, implants cannot be chosen  exclusively on this basis.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Too large breast implants

+1

It is all relative. You have to evalute each individual for the quality of their tissues, their anatomy, etc..  A 375 cc implant may be too large in one individual and not in another.  BTW, I put in 375 or more in many patients.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Question about big implants

+1

While I concur that big implants can lead to big problems, I would not say that 375ccs is too large. It might be for some patients, but that might a very nice and appropriate size for others. It's relative to your frame and skin envelope.

Ann F. Reilley, MD
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 7 reviews

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