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.

Dear Tishaann,

while 650cc may sound large at first, your breast dimensions and skin envelope may accommodate larger implants. You are a perfect example of a patient who can benefit from Vectra 3D breast imaging. You can visualize your desired outcome with different breast implant sizes and make the best choice with your plastic surgeon. Please see the link below to find a surgeon near you who can provide this service for you. Best of luck. 

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

This is always the dilemma. How to choose size. Generally surgeons use multiple methods to arrive at the best size to achieve your desired result but nothing is perfect. I have found using sizers to be imperfect. The sizer doesn't usually fit your bra well, it is not in the anatomic position it will be after surgery ( subglandular or submuscular) and you have it on for a minute or two- not a lifetime. I always find patients choose larger than I recommend. Likewise computer imaging is also not ideal. It does provide you with an image that gets close to the real result but the photograph can't always reliably reproduce your own tissue characteristics. The larger you go in implant size- the larger the diameter and if the diameter exceeds your breast width- there is a real risk of early and late implant malposition and overstretching of the pocket. Best to bring photos of desired size and have a thorough discussion with a well qualified Board Certified plastic surgeon. I suspect 650 is probably a bit large but best to have a second consultation with your surgeon.

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