I already had my breast augmentation and have slightly bottomed out. I went with my max, which was 390cc's (5'2,98lbs,34Acup). What does going with your max mean? Is it the max size the surgeon can fit or the max size without risking size related complications....both? I just wonder what my max should have been now that I've bottomed out.
What Does Going Your Max Mean?
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Augmentations to the Max
Choosing a breast implant brings together several factors
a) Patient desires in terms of the cup size the patient wants to achieve.
b) Patient lifestyle and activities (exercise, sports, etc.).
c) Patient measurements (for bio-dimensional planning) -- such as breast base diameter, sternum to nipple distance, etc.
d) Judgment of the surgeon based on the above measurements, elasticity of the skin, and evaluation of the patient in person.
In that sense, there is no "max", but a range of sensible choices.
Within the range of implants that are suitable, some patients choose to be on the larger side and some on the smaller side. I tell my patients that I am like a waiter, I tell you what's on the menu, and you tell me what you want to eat, but I will also tell you what the chef recommends! It's also my responsibility to prevent patients from making bad choices.
The implant you chose was probably correct for your body and you have had unanticipated complications -- namely, bottoming out. Luckily, you can discuss this with your surgeon and correction should be possible by re-adjusting the pocket.
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Augment to the max
I would like to see a picture of you with your arms at your sides. I think your position distorts what we see. it does seem to be a fairly large implant, it is difficult to be precise about what the max is. i have gotten away with implants that size in someone your size , but the larger you go the more risky it is. it seems clear that for you the max has been reached and a revision would involve smaller implants.
Augmenting to the max
The maximum size in my practice is the largest implant that will fit the natural horizontal dimensions of your chest and the laxity or tightness of your tissues. The volume can be variable based on the profile of the implant, but the diameter is set by your build. An implant that violates the diameter will end up in your armpit, create "unaboob" a.k.a. synmastia, or be too tight and constricted. None of these are good things. I sometimes turn patients away when they have the "go big or go home" mindset. Too big implants just set the patient up for problems. You body sets the limits, not your or your surgeon's imagination.
Lisa Lynn Sowder, M.D.
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You will revision including going with smaller implant
You have very small amount of breast tissue and your implants are too big for you. Revision of the implant pocket will not work will because of the implant size that you have.
Maximum volume for breast implants
Although there is no absolute maximum volume for breast augmentation, a plastic surgeon must take into consideration the size and shape of the patient's chest, the elasticity of the skin and/or muscle, the shape and amount of breast tissue, as well as other factors before determining what size range would be appropriate or feasible. Each patient is unique, and most plastic surgeon will counsel patients on a reasonable size range for their particular situation.
Choosing the maximum implant size may not be your best option.
Choosing the right size, shape and surgical technique for each breast augmentation patient requires an assessment of your tissue, extensive experience as well as you maintaining realistic expectations. It is not technically more difficult to place a larger or smaller implant. However, larger implants mean more risk of the problems that you are experiencing.
Plastic Surgeons must make recommendations based on an objective assessment of your tissues. Measurements of the amount and quality of your tissue is critical. These measurements combined with the experience of your surgeon allow for a recommendation of size, type of implant and surgical technique to achieve an augmentation with a low risk of complications. When cup size and implant size are used to make recommendations, the incidence of complications is much higher. Larger implants result in more stretching of the tissue which may produce very nice early results. However, over time the larger implants have a higher incidence of "bottoming out", ripples, dynamic distortions, "double-bubbles", sagging, asymmetries and sensation changes. Even when careful assessment and conservative recommendations are made, your tissue may not be able to support the implant over the long term.
Too many patients are given good advice but then insist on choosing larger and more projecting implants than recommended. As a Plastic Surgeon, I frequently have to decline offering surgery to patients who insist on larger implants or want to achieve a certain cup size. Patients often listen to unqualified advisers that say "choose larger than you think you want" to avoid being disappointed. Unfortunately, the "bottoming out" and rippling of your breasts will get worse with time. I hope that you are one of the lucky ones where this progression of changes occurs slowly.
Max volume for implants
I just answered your question about implant rippling and bottoming out. Implant sizes are chosen together by you and your plastic surgeon. It is the surgeon's responsibility and duty to give you the best advise based on your physical examination. Implant size is picked based on you chest wall measurements, breast base diameter, quality of the breast skin, compliance of the envelope, how much breast tissue you have for coverage. I personally do not deviate significantly from my preop measurements and my recommendations. I tell my patients that I'd rather not do their surgery if I think that they have irrealistic expectations. I believe the implants you have are too large for your frame and the inframammary fold is overdisected. You would've done better with a modest augmentation (230-260cc) with silicone gel implants for a better long term outcome and avoiding future reoperations.
Max has different meaning to different surgeons
In general every surgeon has a limitation where the risks of placing a larger implant does not justify the risks of complications and poor aesthetic outcome. Form many surgeons including myself, the base width of your breast is the maximum footprint to any implant to be implanted.
With regard to bottoming out, it is difficult to evalulate with a single photo with arms raised.
Chen Lee, MD, MSc, FRCSC, FACS