My PS Gave Me Much Bigger Implants Than I Requested! They Are HUGE for Me!

Sept 30,10 I had breast augmentation, I was 34AA(loose skin), 5"4 110, 39yrs. I have two children 19 and 20yrs old. I requested from my PS a small size,conservative, did not want anything big. My PS indicated he needed to fill in the sac. He gave me 450cc silicone under the muscle? I want a small size as I initially requested. Would I sag now more if I go to 300 or 350cc? Will I need a lift? I am very UNHAPPY!! I dont understand his reason for going that big.

Doctor Answers (14)

Unhappy

+1
Unfortunately, without a complete history and physical exam and through pre operative photography there is not enough information to make an informed plan, please consult your surgeon or another local board certified plastic surgeon


New York Plastic Surgeon
5.0 out of 5 stars 36 reviews

Choosing Your Breast Implant Size

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Montebello- unfortunately you didn't provide photos so that we could understand your version of HUGE. Since you had saggy breasts preop what your surgeon probably did was to make an educated guess as to the approximate size of your breast envelope. This means he/she determined that 450cc was the size of your skin envelope and this size would be necessary to lift your nipples without the scarring of a breast lift. Many women will go to great lengths to avoid a lift which usually translates into large implants. Going to a smaller size implant will usually mean that you will need a breast lift (mastopexy). There are several incision patterns available so the scarring can be minimalized. You need to have honest communication with your Plastic Surgeon to work out these issues.

Paul S. Howard, MD
Birmingham Plastic Surgeon
5.0 out of 5 stars 7 reviews

Bigger Implants Than Requested

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Breast implant size should be determined BEFORE surgery so that this does not happen.  It is not difficult to do this.  A tight sports bra with an implant sizer in it, with a tight t-shirt over that is the easiest and obvious way.  It needs to be tight to give a body suit effect.

True, it will look a little larger this way than it will after surgery, because the implant is out in front of the breast and not against your chest.  Just factor this in.  Go one size up than what looks good in a bra.

I've done it this way for 20 years and this problem barely ever occurs.  It makes no sense to make it strictly an intraoperative decision.

Also, AA breasts usually do not need 450ccc to fill them out.

Gregory Diehl, MD, FACS
Long Island Plastic Surgeon
5.0 out of 5 stars 6 reviews

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Unless you asked for a specific size implant, your surgeon used good judgement!

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I am so sorry you are unhappy with your results; I would bet your surgeon is equally dismayed, since of course he used all his experience and best judgement to try to achieve your goals!

Let's examine your situation in detail (at least as much as your included information allows): you are slim and petite, and after two children had smaller than A-cup breasts and loose skin. A lift alone would have yielded scars and an ounce less volume (skin removal) than your present quite small breast size. Unhappy result, and more costly operation (and you can't "take the scars back.")

You asked for "small, conservative" results, but did you try on implants to let your surgeon know just what that meant to YOU? (because it obviously meant something else to your surgeon.) Did you bring photo examples of just what "small and conservative" is to your mind's eye? Did you look at your surgeon's and many other website photos of patients with similar size breasts to yours, and what size implants gave them results you liked? If you didn't then perhaps this is a shortcoming of your surgeon's sizing process, because I suspect he can't read minds, and obviously missed the mark with your surgery.

Lest you be too hard on your surgeon, you should understand that 450cc is (by my personal estimation method determined over 25 years and thousands of breast patients) anticipated to add just under two cup sizes to whatever breast volume you started with. At AA before surgery, this would yield a full C cup (perhaps a D-cup bra from Victoria's Secret) for most patients. And of course, we haven't discussed the "(loose skin)" that did require a certain volume to adequately fill so that you wouldn't have a truly unhappy "rock-in-the-sock" result. 450 sounds like a large number, but it is a very common size for someone with loose skin and little breast tissue of her own.

Going down 100cc (just over 3 ounces, or 1/4 of a can of pop) will be a barely-noticeable decrease in size and will increase sag (same skin, less volume) somewhat. Going down 150cc will drop you by just over 1/2 cup size and will increase the skin laxity a bit more.

For now, I'd advise patience and continued follow-up with your surgeon without anger or "blaming." He truly wants you to be happy, and acknowledging that to him while calmly expressing your feelings (which you should understand may change as time goes by) is the prudent way to keep your surgeon on your side rather than defensive. You should also discuss (if you didn't already--always something that SHOULD be done PRIOR to surgery, IMHO) what revisionary surgery costs are and who is responsible for what. Being vociferously unhappy does NOT get you a "free" re-do; it often gets you another surgeon who charges full price. Be well and take care. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 116 reviews

Breast implant size?

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I would suggest continued calm and non-accusatory discussion with your plastic surgeon expressing your concerns. You may find that there is a logical explanation for the size of implants that were selected.

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.

If revisionary surgery is decided upon, it will be very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.



I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 701 reviews

Will downsizing implants leave me with saggy breasts

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This is a relatively short time to exchange implants and it is likely that exchange at this time will not have significantly changed your breasts or have caused more sgging than prior to surgery. In other words, if you downsize and you need a lift, you probably would have needed a lift in the first place. The larger implant was proabably chosen to avoid the need for a lfit

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 43 reviews

Aug size too big

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This is always a difficult question.How big?I didn't see you before but the question is whether or not a simple breast lift with a smaller implant would be the way to go.I would talk to your surgeon and see if he will consider putting smaller ones in to suit your desires.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 14 reviews

Decreasing implant size may not need a lift

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Miscommunication often leads to an unhappy patient and a frustrated physician. Even if the exact implant size is not known, a range should be discussed with the patient prior to surgery. In your situation, decreasing the implant size may or may not require a lift. It is impossible to tell without an examination. Many times the breast skin contracts sufficiently and no removal of skin is necessary. However, if the nipple is not in the proper position, decreasing the size of the implant often leads to a lower position necessitating a lift to correct. I recommend a frank discussion with your plastic surgeon on what you are unhappy with and discuss what can be done.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 11 reviews

Miscommunication with plastic surgeon on breast implant size

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In cases where there is loss of volume in the breast following child birth and the desire is to only increase the overall size (even just a bit), it is not unusual to require some sort of breast lift. In women who do not want the lift incisions, then often a larger prosthesis is required to make up for the lost volume. It sounds like there was a mis-communication between you and your plastic surgeon and that the situation can be readily corrected with replacement with a smaller prosthesis knowing that you may need some sort of mastopexy as well.

William F. DeLuca Jr, MD
Albany Plastic Surgeon
5.0 out of 5 stars 108 reviews

My surgeon put in big implants! Help!

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Before you go into the operating room, you have the right to know what is going to happen there.  You have the right to understand everything clearly, not just the risks and complications.  You have the right to know what the expected results of your operation are.  You have the right to know what the treatment alternatives are, and you have the right to know what the required followup care will be required.   These are all parts of the process of informed consent.  Before you subject yourself to any treatment, make sure that you understand all the components of your treatment plan.  To summarize, you need to know:

  1. the risks and complications of surgery or of going without surgery,
  2. the expected results of surgery or no surgery, 
  3. the required aftercare of surgery
  4. the treatment alternatives (surgical or nonsurgical options)

That said, there are unexpected things that might arise during surgery that require deviations from the plan, but these are exceptionally rare events.  

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

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.