Largest Silicone Implant That Can Get Inserted Through Nipple?

It depends upon the size of your areola, the thickness and firmness of your tissue, whether or not the implant is textured, and the degree to which your surgeon will force adn distort your implants through the incision.
But this all begs the following quesiton: why? Why would you use that incision?
As I see it, that incision has only one possible benefit: that the scar might be good. And that's it. And it's not a guarantee.
But what if the scar is bad? You'll see it everytime you look straight at your breasts. But the underneath incision is hidden by your breast, and is generally visible only when looking from under your breasts when your arms are over your head.
Beyond the scar, the advantages of the underneath incision relative to the areolar incision are overwhelming. One recent study showed significantly fewer capsular contractures with the underneath incision. Why? Because bacteria appear to be the likely culprit in causing capsular contracture, and the nipple incision exposes the implants to more bacteria.
And undoubtedly, patients have more swelling and pain with the nipple incision.
Lots of good surgeons use that incision with great results. I do when patients ask for it, too. But as time goes on, I'm going to predict that more and more studies will validate that study I referred to earlier about capsular contracture through the areolar incision.

There are a few issues to consider here.
While I have performed this procedure without difficulty there are a few concerns that have been raised by surgeons regarding this approach:
An implant of this size requires an incision that is typically a minimum of 4 cm and preferably up to 6 cm to minimize trauma to the implant and the possibility of "fracture". Is your areola large enough to accomodated this size of an incision?
Other surgeons believe that there is a higher potential for bacterial colonization which may perhaps lead to biofilm formation and increased risk for capsular contracture. To the best of my knowledge, this has not been proven but is a concern.
The use of an areolar incision may be more advantageous for darker complected individuals due to lower risk for keloid scar formation around the areola in comparison to the crease incision.

I would say it is a periareolar incision, where we place the incision just at the junction of the breast skin and the dark pigmented areola. It all depends on how big your areola are. If you have very small areaolas, then you may need to have the implant inserted via an inframammary incision.
Hope that helps.

I believe that you are referring to a peri-areolar( around the circular dark skin surrounding the nipple) incision and not an incision in the nipple.
I prefer the peri-areolar incision because the scar is well hidden at the juncture of darker and lighter skin. The areola size will determine how large an implant can be inserted. In order to insert most silicone gel implants, I usually need at least 5 cms (about 2 inches). I have inserted implants greater than 400cc via such an incision.
If the areola hemi-circumference is much smaller than that , the choice is to have a silicone gel inserted via a sub-mammary incision or if you insist upon the periareolar approach you may want to consider a saline implant. I can insert just about any size saline implant via a 2.0 cm (less than one inch) incision.

The size of a gel implant that can be placed using a periareolar approach really depends upon the size of the areola and the size of the desired implant. An areola diameter of about 4.5 cms can probably accommodate an implant in the 300-350 range, anything larger will have to go through a different approach. An areola diameter that is larger can accommodate a larger implant.

To be specific, we do not insert breast implants through the nipple (the raised pencil-eraser shaped portion of the nipple areola complex), we place them via an incision around the areola (the darker pigmented circular area surrounding the nipple).
Since gel filled implants come prefilled, the DIAMETER OF THE AREOLA will determine the ease with which gel implants can be placed through it.
The advantages of the periareolar approach are much more numerous than its disadvantages and among them are a practically invisible scar, the best and unrivaled visibility of the breast implant pocket for the surgeon, re-use ability with use and re-use in breast lift procedures. Unlike the under the breast, infra mammary approach, the periareolar approach does not weaken the shelf the implant sits on which always leads to implant drooping and upward migration of the scar. As a result, you do NOT need to be a dancer to have a periareolar incision - you just need to be intelligent and realize that your breasts WILL need work in the future and a periareolar incision is the only incision that is reuse able for all such future revision or lifting breast procedures.
We have placed a lot of 450cc gel implants through periareolar incisions in women whose areolas were large enough.
I hope this was helpful.

I am assuming that you are asking about inserting the implant through a peri-areolar incision.  The answer is yes but depends on how large the areola is.  A very small areola diameter will not permit this approach.  Hope this helps.
Tracy M. Pfeifer, MD, MS

Hello,This will depend on the diameter of your areola. The average areolar diameter is 3.5 cm. It is not difficult to introduce a 350-375cc implant through this incision. A 450 implant is larger and will require a bigger incision. Hope that helps!

The answer to your question is that it all depends.  It depends on the areolar diameter and its elasticity and the experience of the surgeon.  If you force the implant through a keyhole it will permanently deform the implant and its integrity will be weakened predisposing it to future ruptures.

Several factors contribute to answering your question-the size and stretch of the areola, the thickness of the breast tissue, the profile of the implant and whether the implant is textured or not. If too large an implant is "forced" thru too small an incision the implant can be damaged. Likewise if the areolar incision is over stretched a poor quality scar may result. I will use this incision if appropriate and if patients specifically request it. My preference though is the incision hidden in the natural fold below the breast. In making these types of decisions there are many upsides and downsides-"trade-offs" to consider. When i think of all the known trade-offs between the choice of peri-areolar and infra-mammary the balance swings toward infra-mammary. some of these considerations include, if there is ever need for future surgery, if you do make a poor quality scar, and the early evidence that there may be a slightly higher chance of capsular contracture with the PA incision. As you go thru the decision making process your surgeon will help explain any unique advantages/disadvantages(trade-offs) that apply to you.