How do 450cc implants last over time? (Photos)

Question

I see a lot of patients staying in the 300cc range but I like the look of 450cc when trying on sizers. Will the additional weight and size cause an excessively larger amount of sagging with time? I’m 5’4, 160lbs with minimal existing breast tissue. Do you think my chest can support 450cc?

Roger Tsai, MD · Answer

Great question!  Implant selection can be a tricky process and without measurements, can be hard to discuss.  One of the more important factors is the width of your chest, and you want to pick and implant that is very close to this.  The higher projection you go, the more narrow the implant become if you compare the same cc's.  So a 450cc moderate projection will look different that a 450cc high projection.  It seems like your body could hold a 450cc implant but only with a physical examination in person so that measurements can be made would give you a definitive answer. Best of luck and hope this information helps!
- Dr. Roger Tsai  @DrRogerTsai
Board Certified Plastic Surgeon

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well.. based in your question and the picture you showed you are a good candidate for breast augmentation with implant ., in your case its recommended get a consultation in personal with a plastic surgeon to determinate how many cc do you need to get a very well result.

Urmen Desai, MD, MPH, FACS · Answer

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Kenneth Hughes, MD · Answer

The average volume in the US is 350 cc.  I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy.  Consult with a board certified PS who can help you determine the best size for you. A volume of 450 cc should be placed as a sizer, and you should try them on in the office.  If you like the size, then it is likely that a profile can be chosen that will fit your chest wall.  My patients bring a few garments with them to the exam so that they can actually see how the sizers look under a tight sweater, bathing suit, blouse, work-out tops, and clothes they wear most often.Submuscular or dual plane is a better choice for a number of reasons including reduced risk of capsular contracture and greater implant coverage. Tissue thinning and implant visibility tend to be more prominent with subglandular placement.Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Daniel Barrett, MD · Answer

Dear xStar,
bigger and heavier implants have a greater risk of causing breasts sagging with time . Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question and best wishes on your upcoming surgery.  Overall one can say that the increased weight of a larger implant will increase tissue sagging over time compared to a smaller one but the degree to which this occurs is extremely variable.  As you are young, and have  good tissue quality, I would still recommend selecting the implant size that best approximates your goal result as no one can predict what your breasts will look like in 10+ years based on genetics, pregnancies, etc.  Hope this helps.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate for a breast augmentation.  If good technique is used during your surgery, you should be able to have 450cc placed without risk of bottoming out over time.   The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  
 
 Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. 
With regards to your specific question, larger implants likely age faster relative to smaller implants due to tissue attenuation under the added weight. That being said, the difference is likely negligible until greater weights/volumes are reached.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Andrew Gear, MD · Answer

This is a very important question as the incorrect choice of implant size and style can damage the breast and underlying tissue and lead to additional operations.  450cc is a big device particularly when looking at your left breast.  Choose wisely.

Tom J. Pousti, MD · Answer

Thank you for the good question. It is not necessarily that larger implants are more problematic;  it is that the use of a breast implant  that is TOO  large for a patient's frame can be problematic.  
Generally speaking, every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery.    In other words, a patient's starting anatomy will limit how large of a breast implant can be utilized safely. The use of a larger breast implant (than what is safely "allowed" by the patient's anatomy) can be problematic;  potential problems include breast implant displacement/malpostion issues ( such as bottoming out, lateral displacement, symmastia...)  and/or significant breast implant rippling/palpability.
Generally, in my practice, I suggested patients aim for an outcome  only as large as "necessary" to make them happy; pushing the envelope can be problematic.  Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.

How do 450cc implants last over time? (Photos)

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