Would Like 700cc Implants, Why are Some Doctors Against That Size? (photo)

There is nothing at all "wrong" with larger implants, if you have the desire for that size and anatomic capacity to allow them. I have done breast augmentation for over 25 years, and do well over 100 cases of this specific operation each year, as does my partner. We have no specific reservation about large(r) implants in the appropriate patient who wishes them, and these patients do not have an increased incidence of "bottoming out," capsular contracture, or other complications compared to women who choose smaller implants.

Of course, smaller implant placement is a tiny bit easier and requires a correspondingly smaller pocket to be created surgically, but these are truly trivial in the entire scope of this operation. We charge the exact same price for implants of ANY size, and the same exact price for the operation, so this should give an indication of the scant difference between one size vs. another.

Perhaps some surgeons who are "against" larger implants are simply trying to seek a less "done" or "over-the-top" look. Some surgeons may "fear" larger implants because they may 'bottom out" more than smaller, lighter implants, although I believe this is related to (too low) placement and failing to take into account the effects of gravity. I believe that even large(r) implants, if placed skillfully and with minimal surgical trauma to the tissues, can yield soft and "amazing" results. Other "cosmetic surgeons" may not be fully-trained plastic surgeons board-certified by the American Board of Plastic Surgery--be sure to check credentials! But you have done that, and have the additional input of 4 friends who have seen your surgeon with good results. Trust your own impressions, those of your friends, and place less emphasis on an on-line answer from a surgeon who has not had the ability to examine you and talk to you in detail--including me!

Please also realize that breasts come in all sizes naturally--we do breast reductions as well as augmentations. So "large" is not at all "unnatural," it's just large! What you want is soft and properly-positioned implants. Sounds as if you have found the right surgeon! Best wishes! Dr. Tholen

The size of the breast implant is usually decided based on measurements of your breasts, your tissue elasticity and chest wall shape. As the implants get bigger they also get wider. When the tissues are less elastic certain distances don't change. For example the distance between the midline over your sternum and the nipple. A lager implant has to gain room more on the sides of your chest and the nipples would not be centered on the breast. This is how the dimensions of your chest, breast and the quality of your tissue dictate size. In general the larger you are, the larger breast implant you can tolerate. If you try to bend these rules you may get away with it occasionally but the incidence of complications becomes higher. I hope this exploitation is clear to you and will help you understand the principles behind the reluctance of most plastic surgeons recommending larger implants.

Breast Implant size is a combination of personal preference and your body size/shape.  Even if you prefer a very large implant (greater than 650cc) this may not always be a good choice for you.  The large implant must "fit" your body, meaning that it cannot be too wide for you which will result in "uni-boob" or "side-bood", 2 bad complications.  Also, large implants exert pressure on the inside of your breast. Over time this can cause atrophy, or thinning, of yoru breast tissue and also may cause your ribcage to indent and become concave.  These long term complications are not reversible.  Also, large implants are heavy and can droop, sag, and "bottom-out" over time.  Plastic surgeons are not opposed to placing these large implants in appropriate situations. You need to have a very detailed discussion with your board certified plastic surgeon to see if the choice for large implants is best for you.

I have no objection to larger implants in suitable patients.  This is a decision that needs to be based on multiple variables.  That said, long term studies show more problems with larger implants over the years then smaller implants.  So just a cautionary of "buyer beware" for really large implants.  All the best !  Dr. Joe

This is a very good question.  When choosing your breast implant size there are certain factors that should influence the surgeon and patient.  What is the patients breast diameter?  How much natural breast tissue is available to cover the implant? Does the patient want to look obviously augmented?  Does the patient mind that the large breast size may make her look overweight?  These are important questions because in a smaller patient the larger implant sizes can thin the natural tissue and make the implant more visible through the skin. Also try "wearing" the sizer implants for a day to see if the weight on your shoulders is comfortable.  The goal of any plastic surgeon is to make sure you are well educated heading into your decision for breast augmentation, this prevents any regrets or surprises.

There is nothing "wrong" with 700cc implants, it's just not that common. The average plastic surgeon and patient deciding mutually will settle in the 300-600 cc range but of course there are exceptions.  Aside from individual preference, the major concern that plastic surgeons have with very large implants is the potential for overly stretching the tissues and creating irreversible changes.  

If you are comfortable with your surgeon and your girlfriends' results,  by all means consider proceeding.  It might be helpful to sort out your confusion if you ask your surgeon if he/she has any concerns of long term consequences with very large implants.  Also ask to see longer term (1-2+ years postop) follow up photographs of patients.  

I would make this decision based on your chest wall and breast mound measurements.   In the right patient, a 700 cc implant can offer a wonderful result.   The important factor is ensuring the implant is the right fit for the patient.   Problems occur when large implants are placed in patients too small to safely accomodate the implant size.   

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

There is NO perfect breast implant. ALL breast implants
- RIPPLE (saline filled worse than silicone filled implants). As a result, to hide the rippling and waviness of the implants the woman must have enough soft tissues (enough breast tissue and skin to completely cover the implant). That is the prime reason why we put implants under the muscle; to pile even more tissue on the implant to cover the ripples.  The problem is that many women who wish breast augmentation, by definition, do NOT have a lot of breast tissue in the first place. (This is similiar to going to the bank for a loan. The bank MAY loan you the money IF you have collateral. But - if you had collateral you may not have sought a loan in the first place...). Without sufficient breast tissue coverage, a natural and attractive result can only be obtained with smaller implants which FIT your breast coverage and chest  wall. While some women with ample breast tissue MAY loog good with large implants most women will not.
- WEIGHT - breast implant are filled with saline or silicone gel. This adds weight to the breasts. Weight results in slow disappearance of some of the breast tissue AND in breast sagging. The heavier the implant, the faster the sagging. Going with smaller implants prolongs an attractive result and the reverse is true with lage implants.
- IRERVERSIBLE CHANGES. Breast implants create irreversible changes which cannot be reversed by the removal of the implants. Every experienced Plastic surgeon has seen them. Since most Plastic surgeons are ethical and want to create beautiful results AND happy patients we tend to shun away from operations which create long-term disappointment and unhappiness.

The fact that so many surgeons are telling you something without a financial stake in this matter should serve as a cautionary tale. proceed carefully.

Good Luck.

Peter A Aldea, MD

If you know the look you want and the 700cc implant will fit you frame and meet your needs there is nothing wrong with a very large breast implant. You hear cautions because some of us have been in practice a very long time and have seen the thinning and translucent appearance which can develop. If you are certain, go with it.

Best of luck, peterejohnsonmd.com

In general, the larger the implants, the more likely they will sag sooner.  The larger implants also usuall yhave higher complication rates.