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.