Follow up: Revision surgery again. Considering going larger. Advice? (photos)

Good afternoon!I perform over 200 XL augmentations a year, and I think if you're going to go bigger just make sure you do it the right way- with an experienced XL surgeon and a good Internal Bra suture support technique to provide long term support. If you are currently 1000cc, then it is unlikely you would be able to go all the way up to 2000cc in one surgery- more than likely there would be a middle stage- like going up to 1500cc-1600cc and then waiting 6 months and going up to 2000cc. Only so much will fit at a time, and the larger you go the less additional volume will fit at each stage. For instance it is much easier to go from 400cc to 1000cc than it is to go from 1400cc to 2000cc. The larger you go the more careful we have to be to avoid any potential complications. I have attached a link to my XL Breast Augmentation photo gallery- hope it helps!

Dear GratefulJ,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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for the question. Unfortunately, online consultants will not be of much specific help to you; nothing will replace in-person evaluation when it comes to determining whether your tissues (anatomy) will allow for safe "upsizing" revisionary breast surgery.  As you likely know, sometimes additional measures such as "internal bra" or capsulorraphy techniques are helpful when performing this type of surgery.

Generally speaking, every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery.    In other words, a patient's starting anatomy will limit how large of a breast implant can be utilized safely. The use of a larger breast implant (than what is safely "allowed" by the patient's anatomy) can be problematic;  potential problems include breast implant displacement/malpostion issues ( such as bottoming out, lateral displacement, symmastia...)  and/or significant breast implant rippling/palpability.

My best advice:  seek consultation with well experienced board-certified plastic surgeons who demonstrate lots of experience with this type of surgery.  Keep the priorities of safety and avoidance of complications in the forefront when it comes to decision-making.
  Best wishes.