650cc Breast Implants? Am I Crazy? (photo)

But it's important to recognize that there are anatomic limits for each and every patient, regardless of their goals. Perhaps your surgeon's recommendation is 475cc because s/he feels that this is your anatomic "limit" based on breast base diameter, muscle tone, skin tightness, and rib cage configuration. Perhaps s/he has little experience with large(r) implants and really is concerned about his/her ability to give you a good result. It's impossible to know what is in your surgeon's mind, and (only slightly more so) what's in yours based on one small paragraph and a couple of clothed photographs.

But that's why you and your surgeon need to have this discussion, in detail!

That being said, just in the past few days I have placed two pairs of 650cc implants, one pair of 700cc implants and two pairs of 680cc implants. None of these women were especially large or "Amazon" women! And since I see each of my patients the next day, I can tell you that none of them looked especially "top-heavy," overly huge, and not one felt she was "too big."

I also used a pair of 325cc high profile implants in a very petite woman, and she looked rather "busty" the next day. Not too big for her goals, but comparatively large compared to the women with double the implant volume. Just goes to show the diversity of women and their results!

What these and thousands of other patients have taught me is that it is their body, their money, and their goals I am being asked to surgically achieve. What they must understand is that I have done this before (they have not) and if they're smart, they should rely on my training, experience, and surgical judgement to best achieve their goals--I am not simply a technician following their wishes and decisions. Collaborative decision-making has always yielded the best results and the fewest re-operations for different size implants!

Without a personal examination, as well as experiencing the actual surgical findings at the time of your operation, it is truly impossible to answer your questions truthfully. Based on the (incomplete) information given, most of my colleagues here think that 650cc implants are "too big." They may be right.

But they could be wrong too, and you could end up having a second operation to place the very size of implants you were discouraged from utilizing.

The only way I see to honestly address this "stalemate" is to obtain several more in-person opinions from ABPS-certified plastic surgeons with lots of experience in breast surgery who have had the opportunity to examine you, talk to you, and listen to your goals. See what they think. Ignoring a patient's sizing impressions is foolhardy, IMHO.

Ignoring several qualified surgeons who have examined you in person would be equally foolhardy. So get going and don't have surgery until you feel confident that you and your surgeon are on the same wavelength about implant size and profile. Best wishes! Dr. Tholen

The photographs show your breasts have slightly descended, have no upper pole fullness and are small.  Unfortunately, you did not tell us your bra size.  If you are a 32 or 34 each 100 cc's of implants corresponds to 1 cup size change.  If you are a 36 or 38 each 200 cc's of implants corresponds to 1 cup size change.  The best implants are silicone gel placed retro-pectoral since they look and feel more natural and are less likely to ripple.  It is very likely that you could never accommodate 650 cc implants retro-pectorally.  It attempted, your implants will extrude inferiorly and laterally requiring revision.  I recommend a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to place the implants, reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  Trying on implants in a doctor's office will not give you an accurate estimate of what can be achieved or the final appearance.  Your goal is to have beautiful breast after one operation, not revisions for complications.

Best Wishes,

Gary Horndeski, M.D.

Some women get huge implants and love 'em while others later regret it when their breasts start to sag.  Which one will you be?  Hard to know, but in my experience 650 cc's is too large.  The 475 cc implants are not small by any means and I agree with your surgeon's advice.  Good luck!