Is it more risky to have larger breast implants?

Question

I want to ask you guys a question about breast implants? Let’s say a women has B + cup size, but she wants to go all the way up to a D cup? Can there be any risks that the larger you go there might be some types of complications after the surgery? Also, I saw videos from surgeons on TV where they make smaller cuts under the arm pit to insert the implant where in the past they used to make a round cut around the breast? After the surgery do they use stitches after inserting the implant?

George Volpe, MD · Answer

If one has a frame that can accommodate larger implants, there are no significant risks to going an implant that may give one a 2 cup increase. If one is pushing the volume significantly, there is a higher chance of being able to feel the implant as there is less skin and breast tissue to cover the implant. Obviously, a larger implant weighs more than a small implant and over the years, especially if one has stretch marks, may be subject to gravity more. One must balance this off with the advantages of larger implants.

William Andrade, MD · Answer

Thanks for your question.  Implants that are disproportionately large for your body frame can be associated with increased risk of problems like visible ripples, sagging, and other issues.  Implants can be inserted using an incision in the arm pit, under the breast, or around the areola.  Every incision has advantages and disadvantages that can be explained in detail during a consultation.  The incision is usually stitched with dissolving sutures.

Gerald Minniti, MD, FACS · Answer

Hello,Complications like rippling, capsular contracture, excessive tissue stretch and malposition, and double bubble are the kind of complications that occur more frequently with inappropriately sized implants. A physical exam from a surgeon who's not afraid to tell you that a D cup is not recommended (depending on your examination, this might not actually be the case for you) will give you an idea of the ideal implant size.Incisions made under the breast lead to the least risk of problems, follow by armpit incisions. Periareolar incisions are the most popular here in Southern California, but actually put you at highest risk for capsular contracture and other problems associated with scaring of the mammary gland. Visit a few surgeons that are certified by the ABPS and are also members of the ASAPS who do a lot of cosmetic breast surgery.Best of luck!

Stuart A. Linder, MD, FACS · Answer

Implants that are larger in volume will reduce the amount of tissue coverage. This can lead to visibility and palpability. Stay under the muscle with proportionate size implant

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.As implant
size goes up, and the natural amount of breast tissue you have goes down, the
less natural a result do you get. One technique to have a more 'natural' result
while still having a large augmentation is to use shaped implants. That being
said, this relationship still holds and with bigger implants the final result
tends to be more 'sculpted' or 'augmented' and more obvious or easier to
identify even when in clothes. Choosing an implant is a complex process and I
definitely recommend setting up a formal consultation with a board certified
plastic surgeon.I hope this is helpful.The best way to assess and give
true advice would be an in-person exam.

Please see a board-certified
plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Aldo Guerra, MD · Answer

Hello Jessica and thanks for your questions. In general, bigger implants do have more problems or complications and also require more revision surgery when compared to smaller breast implants. For years, it has been taught at plastic surgery training programs that implants larger than 350 cc will lead to greater revision surgery and this information is in the FDA mandated guides for patients from implant manufacturers. The armpit incision is an old technique and does allow the surgeon to place the breast implant below and above the muscle. Sutures are performed to close all incisions when an implant is placed in the body. Best wishes always, Dr. Aldo

Curtis Wong, MD · Answer

but life is about living and having what you really want so if you want the biggest possible, realize that you will achieve that but with time, gravity and stretching will impact your breasts and you will eventually require a lift and downsize of what you have.  Some surgeons will refuse to do over a certain size but you can easily find someone that will and who shares my philosophy on life.  Larger implants do not increase risks in my opinion except for a great risk of nipple numbness as the pocket size could damage the nerves.  The armpit approach has the greatest risk for contractures and I try to do everything possible to minimize that risk - I do not use the armpit at all.  All surgeons use sutures to close the wound but some like dissolvable and others permanent.

Joshua A. Halpern, MD, PA · Answer

Thank you for your question. As long as the diameter of the implant matches the patient breast diameter and the volume and the volume is not to excessive for the breast skin envelope there should not be any problems. I hope you find this useful.

Brian K. Brzowski, MD, FACS · Answer

Your body and breast tissues have a limit as to how much weight they can hold without premature sagging and other stretching type of problems.  While we aren't perfect at knowing exactly where that line is, experience and careful analysis of your tissues should help direct our advice.It is generally safest for patients to "pick the smallest size implant that is big enough to make them happy".Regarding incisions, there are indeed several options, and you mentioned a couple of these.  However, you have neglected the one incision that is the most commonly used by plastic surgeons here in the US:  the incision at the fold of the breast.Lastly, sutures are needed to close the incision used for the implant insertion.  This closure is typically finished with a gauze dressing and tape to cover things for a day or two.Hope this helps.Best of luck.

Paul J. Leahy, MD · Answer

Thanks for your question. Yes, I think that's a fair statement that the larger the implant, the more likely longer term issues may come about such as bottoming-out, implant visibility, etc. I'm not aware that the risk of implant rupture is necessarily higher w/ larger implants, but that has been suggested in the past. Going from B to D cup is Ok, and ultimately you need to choose the size that you will be pleased with. Best wishes.

Is it more risky to have larger breast implants?

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