600CC Silicone Implants Look Small on Me

Question

My first Ba I had 340cc overs mod profile and was unhappy as they looked too small. I had my 2nd ba 3 months ago and went for 600cc HP silicone under the muscle.

	I was really gutted to find I still haven't got the desired projection I was after. My surgeon said it's because I have a high rib cage which is why my implants dont project much. Should I consider a ultra high profile saline implant or just accept the fact boobs don't look big on me??? Please help!!! Thanks

John E. Sherman, MD, FACS · Answer

The choice of implants in Europe are greater than what is offered in the United States. It is hard to imagine that regardless on the projection and the type of implant that your surgeon used, a 600 mL implant should have more than adequate projection. It sounds like your expectations need to be addressed by your surgeon and to really see if they are realistic and obtainable.

Richard J. Bruneteau, MD · Answer

It's virtually impossible to make a specific recommendation without pictures or a physical examination in this particular case. Under most circumstances, 600 cc implants would be considered large and would be expected to yield large breasts.Your history of a chest wall abnormality may explain your problem. In patients with prominent sternums with laterally sloping chest walls, the majority of the implant may set behind the sternum.Under these circumstances, switching to larger, heavier implants might actually make the problem worse. For this reason, it may be reasonable to accept your current result.

Michael M. Omidi, MD, FACS · Answer

Thank you for the question. 600cc implants are relatively large. At this time, you are still in the recovery stage so your implants may not have settled in fully. Best to wait until 6 months for the results and if you are still unhappy about it, you can go to your board-certified plastic surgeon and discuss your options. Best of luck. Dr. Michael Omidi.

An
in-person exam with a board-certified plastic surgeon is the best way to assess
your needs and provide true medical advice.

An
in-person exam with a board-certified plastic surgeon is the best way to assess
your needs and provide true medical advice.

Raj S. Ambay, MD · Answer

I think it would be helpful to see pictures. 600cc implants are fairly large. A higher profile may give you another 05cm or 1 cm. I don't know is that would be acceptable or worth another surgery. After a certain size the short term satisfaction is overshadowed by the long term issues that can occur with very large implants. I would have a serious sit down with your plastic surgeon to access your expectations and his/her ability to meet them realistically and medically.

Florence Mussat, MD · Answer

Hi,

	It would be nice to know your height and weight, current bra size and the one you wished to obtain, and to have your pictures. 600 cc silicone implants are already fairly in the " large range " and if you think  this is looking small, there are sizes up to 800 cc.

	But I would tell you as I tell all my female patients, bigger does not mean better, but more problems.

	it may mean an additional surgery of course, added weight to carry on your chest which may give you back and shoulder pain in the long run. Also, an added risk of " bottoming out " because of the heaviness of such implants onto thin tissues. You may also find it difficult to exercise.

	I would recommend you discuss all these issues with your plastic surgeon.

	Good luck,

	Florence Mussat, MD

Tom J. Pousti, MD · Answer

Much of the final &ldquo;look&rdquo; 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 &ldquo;look&rdquo; 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&rsquo;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&rsquo; 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 &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; 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. By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.

	 I hope this helps.

Todd C. Case, MD · Answer

The appearance following breast augmentation is not entirely predictable. Some patients get the half grapefruit look and others more sloping or "natural" in appearance. The look will depend on many factors, not only the size and shape of the implants. High profile implants will provide the most projection. "ultra high profile" implants are not available in the USA. Without examining you, it is hard to say what may be possible to help you achieve your desired look.

Steven Wallach, MD · Answer

It is difficult to say what would be best for your without an exam.. In the US we do not have ultra high profile implants avaialble. I usually get nice results with the high profiles.

Chen Lee, MD · Answer

Sizing an implant to achieve a desired shape and projection can be a challenge. The final projection and shape achieved depends on the following: 1) the underlying chest wall supporting the implant. A flat foundation will allow the implant to fully express its projection whereas a tilt to the chest wall will result in loss of or uneven projection to one side. 2) from the underlying shape of the implant. The actual measured dimensions of your implant to the dimensions of your breast envelope is more important than the brand model marketed. 3) the tissue plane of implantation and its resistance to stretch is another major factor on both projection and the visibility of the implant margins. As surgeons, we can only control the selection of the implant model and the tissue plane of insertion. Perhaps you should have another visit (with your surgeon or another experienced opinion) to review the various suitable dimensions of implants to be tried via sizers in the operating room to better approach your goals. Furthermore, submammary placement is more likely to achieve the full implant projection then submuscular placement, however, the implant (especially saline implants) will show ripples and edges in this submammary plane.

Roger J. Friedman, MD · Answer

There are several issues which impact on the projection of breast implants. One is the actual profile, High profile project more than Moderate plus.(600cc HP Gel project 5.6cm and 630cc HP saline prejuect 5.9 but can be over inflate to 750 at which time they project 7.4cm). The second issue is your rib cage. Some people have a flat rib cage who will then get the full projection of their implants. If alternatively your rib cage falls off to the side, you will lose projection as the implant is also falling off to the side.

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