Is breast implant revision surgery typically an additional charge? (Photos)

The term bottoming out seems common and PS answers suggest revision surgery. I would like 700 cc high profile, under the muscle, breast crease incision for myself. I am 26 with no children, 119 lbs. A previous consultation suggested 400 cc would be max for my frame but I am not pleased with that answer. 700 cc seems reasonable without the risk of bottoming out and damaging my breast tissue. Perhaps mesh implants in w/the 700 cc implants would prevent this? My goal is big volume w/side boob (lol)

Doctor Answers 11

When wanting larger implants

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as you do, you can anticipate problems will develop with time and that you will then need another procedure (at more cost) that will involve and mastopexy and downsizing of your implant.  Also, without the benefit of knowing your measurements and what you liked with external sizing, its impossible to recommend a size for you but the bottom line is that your body will have be able to support the footprint of whatever implant is selected so your surgeon who said 400 cc max could be right.  The worst thing you can do is to make yourself look ridiculous, unless that is what you really desire.  Then you need to find a surgeon (and you can) who will accommodate your wishes.


Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Best Result

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Thank you for reaching out and sharing photos. It seems that you are petite framed, 700cc's is quite large. If a surgeon suggested 400cc's that was based on your measurements, not to say you could not slightly larger, but 700 seems like a stretch. But that can be best determined with an in person consultation, maybe be a few "wish" photos and be sure to see experienced board certified surgeons. best of luck! Dr. Kachenmeister

Robert M. Kachenmeister, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 28 reviews

Revision surgery fee after large volume breast implants

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700 cc is a large volume implant in the average person, and based on your photos, you look petite and slender, making it even larger relative to your frame. Achieving large volume breasts with side boob does not require 700 cc implants. Some patients achieve this with far less. It really depends on your frame, breast dimensions, and amount of preexisting breast tissue you have. Based on the photos, I am not surprised that a surgeon in consultation told you the max that would fit was 400 cc.  An in person consultation and evaluation and measurements are required to determine what size implant could fit in your frame. (It's not something that can be determined by photos alone.) There is a limit to what can fit at any given time. You could decide to go with the largest that safely fits, and then once your skin has relaxed some over the following year, choose to go larger.  Bottoming out is a risk, and can happen when the skin stretches due to the weight of the implant surpassing what the tissue can handle holding up. You can get bottoming out even with modest or small sized implants, and the risk is even greater with 700 cc implants in a small frame. You can also get stretch marks with large volume expansion in a short amount of time, so that is one other consideration. I think it is great you are doing your research to understand the risks associated with large volume breast implants. Generally speaking, the larger the implants, the greater the risk of problems. The revision policies for surgeons will vary. Generally speaking, the cost of revision surgery is not included in the cost of your first surgery, and will be an additional charge if and when needed. If you decide to go with larger implants, by doing so you are accepting the increased risk of needing a revision, and should plan accordingly. If there is an unanticipated result, then the surgeon may reduce her/his fee, but the patient would still be responsible for the OR and anesthesia fees. Bottoming out is one of the known increased risks of choosing a larger implant, and typically there is a fee to correct it. Revision surgery is typically more expensive than the initial surgery. Hypothetically speaking, if the 700 cc implant fit in your breast, yes the surgeon could do a reinforcing maneuver such as mesh or other technique to help prevent bottoming out. This would be an additional charge since it is an additional step, the procedure will take longer in the operating room, and you would also have to pay for the mesh or other material used. 

Anita Patel, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 12 reviews

700 cc implants

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Without examining you in person it is hard to say what implants would be right for you. In general,  a 700 cc implant will likely be too large.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Is breast implant revision surgery typically an additional charge?

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Thank you for your pictures and questions. You need to have a consultation with a surgeon to discuss these issues. First, based on your frame and photos, a 700 cc implant is very large and I think puts you at risk of  a poor outcome. And second, if a surgery does need a revision, this cost is usually the responsibility of the patient. There is no guarantee of a good outcome, especially when you do not follow the advice of your ABPS certified surgeon.

Hope this helps!

700 cc HP implants

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You appear to be a perfect candidate for a breast augmentation procedure. You have a fair amount of your own natural breast tissue, no sagging, and a nice natural shape. Implants will fill out, round out and basically expand your existing breast dimensions depending on the specs of the implant selected. Breast aesthetics is very personal and individual. Most people would think a 700 cc implant is too big for you.  But, if it can be done safely and reliably and you understand the potential problems that come with large implants on small frames, then I encourage you to pursue your aesthetic goals. You need to pick a skilled surgeon, one who deals with more complicated breast augmentation cases, and you need to go on at least a few consultations to hear different opinions. Finally, pick the surgeon and office you are most comfortable with and proceed from there. I hope this helps!

Thomas Taylor, MD, FACS

Size

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Size is an individual decision based on measurements and putting implants in a bra till you see the volume on your chest that you like.  Then your surgeon can choose the best shaped implant for you.  So on on some Complimentary consultations with experts and compare recommendations and look at photos of similar patients 


Dr Corbin  

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

Is breast implant revision surgery typically an additional charge? Yes...

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Thank you for the question.  Based on your photographs, I think that you are starting a good place and should have a very nice outcome with breast augmentation surgery.  


 You are correct in that over dissection of the breast implant pocket and/or selection of a breast implant that is to large for a patient's frame can be problematic, including greater risk of implant displacement (symmastia, bottoming out…) concerns.   In other words, every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery.    


Policy regarding coverage of expenses for revisionary surgery will vary from office to office and probably on a case-by-case basis as well. Costs of revisionary surgery may range from zero,  to anesthesia/surgery center fees, to discounted surgeon's fees.



Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.


 Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:


1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.


2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "D or DD cup” etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.


3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.


 I hope this helps. Best wishes for an outcome that you will be very pleased with. 

Wants and Desires vs. Reality

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Thank you for your question. After performing over 3,000 breast augmentation surgeries and devote a large portion of my practice to revising breast surgeries, I have some perspective for you. Many times the patient wants a certain number of cc's such as a 700 cc implant, however when I perform the surgery, many times, there is only a certain amount that you can fit in. Despite making a large pocket, the skin can only stretch and accommodate a certain amount of volume.  The discussion with the patient is often "I will place the largest implant that will fit". Often times, an ultra high profile implant will be the type of implant will allow the largest volume in the pocket without making the breasts look to wide or flat. Unfortunately, the larger implant, the more the areola will tend to stretch and many of these patients do get larger areolas. This is why a very frank and candid discussion with an experienced plastic surgeon is necessary to evaluate other patients' pictures, achieved a desired result, and understand the consequences of larger implants. Best wishes to you.

Paul E. Chasan, MD
Del Mar Plastic Surgeon
4.9 out of 5 stars 46 reviews

Implant size and type

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Dear CuteRoute,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS 

Certified, American Board of Plastic Surgery  

Member, Am. Society of Plastic Surgery


Daniel Barrett, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 84 reviews

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.