Breast Implants for Small Breast Tissue Large Chest Wall , A to DD is It Good Choice? (photo)

I am post gastric bypass, 5'5" 165lb 38Acup. I lost 130lb, I was a 40DD.Three surgeons don't believe I could go to DD again. Im not understanding why I can only be a small C. The last one gave me a 3d scan and poss. augmentation measure from my base measur. This is an actual picture of my chest and poss augmentation to a small C. The base width and the Height It ends up being I feel is only enogh to seem lifted not bigger.He plotted with115-322/354/378 Nat.Biocell Midrange Sili.ANY other suggets

Doctor Answers 16

Breast Implants for Small Breast Tissue Large Chest Wall post weight loss

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The size of the implants are based on a combination of a patient's goals and objectives and her anatomy. In order to provide a natural looking augmentation, the surgeon needs to evaluate many factors including soft tissue coverage, skin laxity, chest wall width, breast imprint width, the shape of the breasts and relative level of constriction to ensure that the breast implants are appropriate for to your body. Consult with 3 experienced and expert board certified plastic surgeons to understand your objectives.

West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Implant Selection Process

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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

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

It can be done

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Placing large implants in the breast that has lost significant volume is probably going to require an internal brassiere with acellular dermal matrix. This is a tissue product that forms a sling on the lower half of the breast and is sutured to the chest wall along the inframammary crease and lateral gutter and superiorly it is sutured to the chest muscle. The implant is then placed behind the muscle and into the sling. The overlying skin would probably need to be treated with a mastopexy.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Augmentations after gastric bypass.

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Placing very large implants in post-bypass patients lead to the same issues we see in any patient with over-sized implants, only much sooner. The problem is the laxity of the tissue. Large implants over 400 or 500cc are heavy and will eventually droop over time. Even with a lift (which appears that you will need based on your photos), the implants will sag. This can be prevented to some degree with a dermal matrix to provide internal support, however this adds significant cost to the procedure. Remember that when you weighed 300lbs, the DD breasts fit your body type. With your new figure, this may seem completely out of proportion.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

A to DD for breast augmentation

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Thank you for the question and photo. The problem with going large is that your breast tissues have probably thinned and will not likely support such a large implant long term.  It may look good for awhile, but the implants will weigh heavily on your tissues and cause worse thinning and rippling over time. You may be able to go with a larger implant if you have a wide base diameter. To be sure, see at least two board-certified plastic surgeons for an evaluation. Clarksville, TN is not that far away.  I'd be happy to give you my opinion if you want to make the trip down for a consultation.  My office number (615) 656-7202. Best wishes.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Implants after large weight loss

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Without an exam it is hard to say what would be best for you.  Yes, you may have a lot of excess skin, but remember the larger the implant, the more likely they will sag sooner especially with skin that has most likely been stretched like yours.

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

DD augmentation should be possible

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You may consider one or two more consultations to get several opinions as to whether you can achieve your goal of a breast size of DD.  After a 130 lb weight loss you should have enough excess skin to accommodate a large enough implant to get you to a DD cup.  Good luck!

Don't always believe the computers!!

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Computers can not pinch on your skin and assess the degree of elasticity loss after massive weight loss. The post op 3D image doesn't seem to have a handle on the possible need for a lift and your short nipple to fold distance that could lead to double bubble.

I believe that based on your photos you could get DD again with the correct implant, but you may need a mastopexy depending upon how the skin fills out.

As you embark upon larger implants be sure you are comfortable with the late consequences such as thinning of the skin and droop. 

Discuss with your surgeon whether to consider a lift from the get go or take a wait and see approach.  Both are reasonable options as long as you are on the same page.


Best wishes





Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 115 reviews

Implant choice and base width

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Based on your photo on the left, you appear to have ptosis (droopiness) and need a mastopexy (lift). Also, your breast base width appear to be narrow and thus will not likely accommodate a large implant to get you to a DD cup. High profile implants will allow you to put more volume in a narrower base, up to a point. When you get into larger implants (over 500 cc), there are other potential risks. You should discuss your desires and concerns with a board certified plastic surgeon.

Todd C. Case, MD
Tucson Plastic Surgeon

Breast augmentation together with breast lift

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I assume the left photo is your current condition and the right is a computer simulation of the result. I don't see how you can get from left to right just putting in breast implants. For instance you are not going to shorten the breastbone notch to nipple distance by a half inch+. You may have liked 40DD breasts but 40DD implant breasts are not the same and the effects of gravity on such implant sized breasts will be magnified. Wanting to fill the breast skin envelope rather than cutting it to make it small enough to fit a smaller implant is understandable but not always the best option.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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.