Should I go with 625cc textured gel implants under or 800cc silicone over the muscle? (photo)

I like the look of XL implants. Many people will describe it as the porn star look. The cosmetic surgeon said 800 cc overs will give me the look I want. The board certified plastic surgeon said 625cc is as big as my frame will accommodate. I just don't think 625cc gel will give me the look I want. I have been saving for thisand do not want to regret going with the smaller/ safer option, even if it prevents a breast lift in the future. Will 625cc unders give me the look I desire? Thanks for your time.

Doctor Answers 14

Should I go with 625cc textured gel implants under or 800cc silicone over the muscle?

Perhaps I should not be so honest, but by the photo you showed of your desired result it is obvious that you are not looking for anything resembling a human breast, but instead are striving to achieve the appearance of an over-inflated balloon ready to pop.  You also seem to be willing to accept the irreversible damage that implants of this size are likely to cause to your tissues and skin, including thinning, stretching, bottoming out, etc. This will likely, over time, lead to further surgeries more complicated and more costly in an attempt to deal with these problems.  Please think long and hard about this decision, your reasons for wanting such an extreme and, in my opinion, unattractive result, and consult with one or more legitimate board-certified plastic surgeons so that you fully understand what you are getting yourself into.

Alignment instead of excessive large implants

From your before photograph, it is obvious that you need a lift. Large implants will not achieve the look you desire, your nipples will be pointing downward and you will be dissatisfied. I recommend a new technique called Breast Augmentation with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Through the same incision, implants can be placed. Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant. Small round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision. Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it. The best way to achieve the “porn star” like projection is by alignment, not excessive large implants that will displace.

Best Wishes,

Gary Horndeski, M.D. 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.7 out of 5 stars 210 reviews

Extra large breast implants

Hi rainstormrr

Thank you for the question. I hear many women with small breasts want to go very large. I also hear women with heavy hanging breasts want to go very small. "it's always greener on the other side of the fence".



However, i would caution you to think carefully about your decision. 
1. the after pic you show does not indicate the woman's height or frame. 
2. she is wearing a very tight shirt which pushes up her breasts, making them look larger and higher. 
3. Over the muscle implants will look very projecting and forward but has some downsides: There is more rippling, and more likelihood of firm capsular contracture. Further, without the muscle insertions into the breast bone, this size will create tight cleavage, but make it more risky to develop a symmastia ( a symmastia is a very difficult complication to correct when the breasts connect in the middle and form one wide breast) 

Either size will be very large for you and I think, although it may not satisfy your dream size, the smaller is the better option in the long run. Neither will prevent the need for a breast lift in the future. 

Did you try on sizers in the doctor's office? You mention that you saw two different docs; a cosmetic surgeon and a BC  plastic surgeon. Would you be comfortable having someone operate on you who wasn't a board certified plastic surgeon? 

anyone can claim they are a "cosmetic" surgeon and not have to got through the long training and certification process of becoming a board certified plastic surgeon. 

You can also consider an extra high profile silicone implant in the 600-650 cc size range. It will give you the added projection you want and not risk the problems of an over the muscle implant. 

Best to you in your decision. 






Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 17 reviews

XL Breast Augmentation

For the type of look you are after, you are correct that 625cc will not create that much volume. If you are choosing silicone implants the largest available is 800cc. Whether it is over or under the muscle is not as important as choosing the volume of the implants.

625cc vs 800cc implants?

I would recommend you consider having your breast augmentation performed by only a qualified surgeon. There is no question that this would only be a Doctor certified by the  American Board of Plastic Surgery. No other doctor has the credentials, training, and experience to perform this procedure with the expertise you deserve. I don't have enough information on your individual anatomy, height , size etc to give advice on implant sizing issues. I however would recommend  the large implants you desire be placed in the dual plane sub-muscular pocket if you care how your breasts look now as well as in the future. Very large implants placed over the muscle create problems in a very short period of time which are costly and challenging to surgically to correct.

Choosing Implant Size

The size of the implants are based on a combination of a patient's goals and objectives and her anatomy. In order to provide a natural looking augmentation, the surgeon needs to evaluate many factors including soft tissue coverage, skin laxity, chest wall width, breast imprint width, the shape of the breasts and relative level of constriction to ensure that the breast implants are appropriate for your body. 

Consult in person with 3 experienced and expert board certified plastic surgeons to understand your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 36 reviews

Extra Large implants

Be careful going too big. What looks good today may cause real problems in 5-10 years. Large implants will stretch and thin out your tissues and you may be looking at very expensive surgery in the future to correct the problems. 

Having said aid that, implants under the muscle will be supported better. Look for a surgeon who has a Vectra 3D camera. This device can take a 3D image of your breasts and simulate what any implant size and profile would look like on your frame.

Should I go with 625cc textured gel implants under or 800cc silicone over the muscle?

Only IN PERSON evaluation allows us to determine the size for you! But I lean toward the boarded surgeon's advise... 

625 cc or 800 cc implants

I think that these two sets of implants are quite large and may not be appropriate for you. It is best to be seen in person for a proper evaluation.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

600-800 cc breast implants will look abnormal and have increased chance of complications

Thank you for your question and photographs. The desired look that you show looks deformed to me a plastic surgeon for 31 years. You have very attractive youthful natural body frame. You certainly can benefit from breast augmentation. In my opinion implants in the 352 maximum of 400 cc range will give you a beautiful full breasts that look very attractive but of normal size. Once you have implants in the 600-800 cc range serious complications such as capsular contraction, hardening, stretch marks, loss of implant and many others are much more likely to occur. Please consult a plastic surgeon who is certified by the American Board of Plastic Surgery, experienced in breast surgery, and who has next reputation in your community.

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.