Breast Implant Sizing After Gastric Bypass - 650cc Too Big?

After massive weight loss, the elasticity of the tissue is poor. Breast implants tend to "bottom out" fast. The larger the implants, the greater the tendency to bottom out quickly. This then requres redo surgery.
My advice to most patients who have had massive weight loss is to have a breast lift (often with an extension into the armpit), and, if necessary, the smallest implant that gets the job done.
650 cc would in my opinion be much too large for somebody with your frame.

Deflation from weight loss is common in many women. For many women the breasts are the first place where they lose and gain weight noticeably. Breast implant size is hard to determine without being integrally involved in the process. Discuss with your surgeon the sizes you are considering and see if they can supply some pictures of women in your similar situation.

Looking great after a gastric bypass is a true blessing. The last thing I like to see happen is when patients want a very very large implant after losing the weight since their breasts deflate and sag. If someone's breast are maintained in a good position and don't deflate much despite massive weight loss, that's a good sign that they have retained pretty good tissue elasticity and have a better capacity to retain an implant long term than those that completely deflate and sag.
That being said, the implants that are often seeked out are very very large implants such as a 650cc implant for example. In the mastectomy population we put in expanders first then put in implants this size and larger routinely. They don't sag over time but they have the capacity to form good scars and strong supportive elements to an implant. In the case of the massive weight loss population all bets are off. Each case must be taken into account individually by a board certified plastic surgeon prior to jumping to conclusions based on sheer cc's.
Best wishes,
DoctorMeade

That is a large implant, but I would like to know how you came up with the size implant. I generally like to fit the implant to the patient, not the other way around. Meaning I would like to do some measurements and determine how big you want to be by having you perform the rice test: http://www.feplasticsurgery.com/journal/orange-county-breast-augmentation-sizing/66/.
Then I sit down with the patient and go thru their implants size and profile options.

Congratulations on your weight loss! It sounds as if you are contemplating placing a very large implant to "take up" the excess skin. I would caution you that this approach can create very large, droopy breasts that sit low on your chest.
Massive weight loss patients have unique concerns and I would not consider a one-stage augmentation-mastopexy for you. I would recommend a staged approach. This would optimize both safety and cosmesis. The first stage would be a breast lift. If you have excess skin and fat over your lateral chest, "spiral flaps" can be created to "auto augment" your breasts. This may avoid the need for implants.
If you are not satisfied with your size, implants can be placed at a second stage.
Discuss your goals with a board certified plastic surgeon who is familiar with body contouring post bariatric surgery.
Good Luck!

I would concur with Dr. Moelleken' s and Dr. Rand's comments. 650cc is a larger than average implant. and given your history of massive weight loss it is likely that implants of this volume would likely result in breasts with a large sagging appearance. I tend to prefer lifts with smaller implants. However, I do realize that this involves significantly more scarring and I discuss this with patients.

Thank you for the question and picture. Despite your good description of your body type and goals, online consultants will not be of specific enough help to you. 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're 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. I have found that the use of words such as  “natural” or “C or D 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.
 The use of computer imaging technology may also be very helpful during this communication process.

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.
I hope this (and the attached link) help.

Congratulations on your weight loss!  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

The right implant size for you depends upon your goals and the quality of your skin. This is impossible to determine without an examination. 650 cc implants are heavy, and will almost certainly further compromise the quality of your skin over time.
I would suggest seeing a surgeon in your area who has experience with gastric bypass patients, and who can discuss your goals with you while assessing your tissues. Good luck, /nsn.

It is possible that your breast skin is very good and does not need a lift after massive weight loss.
Sizing for breast implant depend on many factors.
1. your present size
2. desired size
3. Amount of breast tissue available to protect the implant. (PINCH TEST)
4. width of the breast
5. Height of the breast
These are few of the measurements we do to recommend an implant that fits your measurements.