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!

All plastic surgeons want their patients to be happy the moment that we complete surgery and hopefully ten years after surgery.  Heavy large implants over time can stretch and thin the breast tissue making them more visible and difficult for revision surgery.  So choosing the "correct" size implant is probably the most important thing to do with the guidance of your surgeon.  I think sizing before surgery is important but does not  guarantee a result.  We have also been working with Crisalix, a 3D breast simulation model in our office.  We take a picture of the patient and then we can modify it to see what the patient may look like after surgery.  You can "try" on different implant sizes by pressing a button. I always tell patients that this is for fun and may give a rough idea but is again, not an absolute guarantee.  Regardless, you should be careful about a large implant size on a smaller frame.  Please continue to spend preop time with your board certified plastic surgeon for the best results.  My best to you.

There is no way to give you an accurate recommendation on size.  We do not know your chest measurements.  You need to be examined to find out if skin and muscle (if you are going under the muscle), will stretch enough to accomodate 650cc implants.  Finally, you did not mention what profile implants you want or that your PS recommended.  There is a big differece in dimensions and projection between a moderate profile 650cc implant and a high profile 475cc implant.

Finally, sizers in your bra are very inaccurate in determinaing an appropriate size.  I would recommend showing your PS pictures of what you desire and follow their recommendation.

You've choosen a very large implant. You will be big and have a whole different life experience from that point on. I think your plastic surgeon was correct in recommending something in the 400 range. I suspect it will make you a full C or even a D. This size looks really good. 600 cc implants are going to have everybody looking and talking about you. 400 cc range will have everybody saying how great you look. 

Thank you for your photographs. I do not know your measurements but I would not recommend 650 mL implants. I believe over time they will cause more harm than good.  

Dr. ES

I don't use breast implants that large in my practice. The result does not look natural and large heavy implants can create a lot of problems long term and short term.I don't try to convince my patients to go smaller, I simply suggest they select another doctor. Before taking the plunge, you may want you use some insert in to a bra to get a little bit of an experience of what you'd be experiencing. Of course this is nothing like the real thing. But finding clotting to fit properly, getting a massage or even sleeping on to stomach could prove to be uncomfortable. In my opinion, great plastic surgery doesn't look like surgery. Ideally, once the recovery process is finished, people forget about the surgery. the result should make life easier. It makes it easier to fin flattering clothing if having body surgery.If you are set in implants this size, be sure to see lots of photos, ask your platic surgeon about complications and sea to several other women who have had implants this size for a year or more to get their feedback

Generally speaking,larger implants increase the risk of complications such as implant malposition, which can be very difficult to correct longterm.  In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.
Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

 

I consider two factors when selecting implants for my patients:
1.Dimensional planning
2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.  If you have decided on saline implants, then based on the gel sizer you select, we can guide you to the saline implant that achieves a similar look.

Hope this helps.
Dr. Basu
Houston, TX