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

So I had a consultation with my PS. I tried on 700 cc sizers and he said I could do 700s (I LOVED them). By reading alot of Q&A's on here I found that most PS's on here are against implants 600+ ... if they are damaging or bad why would my PS recommend them for me? He is board certified and has worked on 4 of my girlfriends and they have amazing results so I want to say he is experienced. Im just confused any help is appreciated!

Doctor Answers 17

700cc implants are just fine . . . IF your anatomy accommodates this, and that is what you want!

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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

Are 700cc breast implants proportional?

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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.

Breast implant sizing and sizers

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The way to understand the issue of 700cc is to think dress sizes. Is a size 12 too big? Not if it fits you. Unfortunately, using external sizers is very misleading and nearly worthless in choosing an implant size, shape, or type. The best way to size the implant is to measure the width of the breast upright with arms down and subtract about 3/4 to 1 cm. This gives you the diameter of the implant that will fit your breast, look natural, and not distort it. The other dimension is the forward projection which is low, medium, or high profile (not necessarily called that) which will fill the breast forward about one, one and one-half, or two cup sizes from where you started and relative to your chest around which doesn't change. You can then look up the implant volume. Starting from a volume choice and working backward doesn't make sense any more than picking a dress size and making it work does. If you were getting a hip implant, you wouldn't tell the orthopedic surgeon what size implant to use. There's more leeway in a cosmetic breast implant but the principle is similar. 

In my opinion, properly fitted and positioned implants do not cause problems regardless of their size or type, but if the implant is too big for the breast, it's going to cause stretching and distortions that will have consequences in looks and long term, just like cramming a foot that's too big into too small a shoe. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Why are Some Doctors Against 700cc Breast Implants?

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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

Peter A. Aldea, MD
Memphis Plastic Surgeon

Larger Breast Implants?

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Thank you for the question.

There is not necessarily anything wrong with larger breast implants,  when used for the right patient. Larger breast implants on a small frame patient may be more problematic and/or complication prone.

Communication with your plastic surgeon will be key to achieving the results you are looking for. Unfortunately, the use of words such as “I really want a natural look, nothing over-the-top” means different things to different people. In other words, what you consider to be natural may not be what your plastic surgeon considers to be natural looking.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

In my practice I use goal pictures to communicate with patients.  With this technique patients are able to demonstrate what they are trying to achieve and what type of looks they do not like as well. 
I also use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 

By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

Large implants

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In general there is nothing wrong with even 850cc implants.  I have used these in some large frame patients and wished I had gone even bigger.  From your picture you do not seem to be a large frame patient.  Without seeing you in person I can not say I would refuse to place 700cc implants but I am sure I would try to talk you out of it.  The result will most likely be so unnatural and with increased risk of complications that it might not be the best thing for you.  In my practice I try to deliver what the patient desires but as a professional I have to make sure that I am not doing something that I would be ashamed of when you tell your friends who did your surgery.

Gary Hall,MD

Gary Hall, MD (retired)
Kansas City Plastic Surgeon

Large Breast implants

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I try and accomodate the patients wishes in choosing a breast implant size and have even placed larger implants than what mention. It is usually better to go with a larger size than what you think you would like because there is definitely a decrease over initial year after breast implants of sometimes up to one cup size.

Potential problems with very large breast implants

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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.

Large Implants More Likely To Cause Problems

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The main reason that I (and many plastic surgeons) discourage patients from using extremely large implants is that the incidence of problems is much higher with these larger implants.  If implants are larger in diameter than the breast diameter, the incidence of malposition, capsular contracture, bottoming out, and other significant problems increases disproportionately.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Nothing wrong with a 700cc breast implant

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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

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.