Breast augmentation after massive weight loss
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.
650 cc is a very large implant
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.
Staged mastopexy and augmentation after massive weight loss
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.
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.
Implant Size in the Massive Weight Loss Patient
Generally speaking, massive weight loss patients tend to experience breast sagging. If an implant is considered in the treatment plan, something needs to be done to tighten up the saggy breast skin. Otherwise, the implant could worsen the sagging or give a very bottomed out look. However, as my colleagues stated, it is difficult to make recommendations without a physcial examination/assessment.
I would first assess breast ptosis (breast sagging) and determine the quality and amount of excess skin on your breast. If a lift is warranted, I would back off and likely recommend a more conservative implant. Then I would consider two factors when selecting implants for my patients:
2.Gel Implant Sizing system
Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. Even your fitness levels and other relevant criteria are taken into consideration. It is you who will decide what you are comfortable with.
Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for.
This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.
650cc is a heavy breast implant and will cause drooping
You need to be examined by an experienced surgeon to both measure your breasts and more importantly, determine elasticity. Given you were a 38D, your breasts have been stretched and probably would accept a 650cc implant, however your breasts may droop quickly with this heavy implant (the average size implant is 350cc).
You may do better going with a 450-500cc high profile implant. This would accomplish 2 things:
- A high profile implant would help to lift and elevate your tissue and hopefully avoid the need for a lift.
- A smaller high profile implant will still give you more projection and a more curvy figure while not maximizing the longevity of your results. The only downside is less cleavage (when you are naked), which can be created by a bra.
Breast augmentation after gastric bypass or weight loss may need a lift as well
After gastric bypass or very significant weight loss the breast often will have an elongated or a deflated appearance. With breast lift or mastopexy we usually consider the position of the nipple relative to the fold under the breast as the key in reshaping. However when there has been massive weight loss such as in gastric bypass the skin or envelope of the breast is just too large for the remaining breast volume. For augmentation to be at its best, the implant should fit the breast like a hand in a glove.
If not, the breast skin and breast tissue may move unnaturally over the implant. If the implant needed to fit the breast envelope is too large for your goals (and a 650cc implant is quite large) then a variation of mastopexy can help tailor the skin around the smaller implant to produce a better marriage between the two. You need not be nervous about the very large implant if this is what you want, but take your time to be sure. Certainly augmentation after weight loss has specific challenges which might deserve second opinions.
Best of luck!
Massive weight loss breasts: mastopexy (breast lift) with implants
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.
Hard to tell if 650 cc breast implants would be the right size for you
I have had a few gastric bypass patients who did not need a lift afterwards. It sounds like your skin does have pretty good elasticity since the other areas of your body have firmed up as you say. The biggest issue is what your goal size might be. If you are trying to get back to a D cup then you might need a large implant like 650 cc but the cautionary note by Dr. Moelleken applies...you might experience significant sagging of your breasts due to the weight of the implants. I would suggest a bit smaller size to prevent drooping of your breasts. Perhaps consider something in the 400-450 cc range. But I would certainly say you need to be seen face tot face by a board certified plastic surgeon in order to giive you the most accurate recommendation.
650 cc breast implants after bariatric surgery
650cc implants in a post bariatric patient will almost certainly cause more stretching and sagging as you age. Consult a board certified plastic surgeon for your options.