What is the max you can fill a 400cc implant and how much width in chest requires stitch revision? (Photo)

Dear jess089,
it is hard to tell for sure without an exmaination, but you will most likely need pocket revision and implants replacement. 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

I am sorry to hear about the problem you are experiencing.  Although some “falling to these sides” of breast implants is quite normal when you lie down, if this occurs “excessively”, it may be a concern to patients.  This phenomenon is called lateral displacement of the breast implant;  it may be of concern from the visual and the discomfort standpoints. Surgical correction is an option.
Generally, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline.    In my practice, I use a 2 layered suture technique (capsulorraphy) to close off the space laterally (towards the axilla). The use of acellular dermal matrix is an option (although not usually necessary) especially if significant implant rippling/palpability is present.
 There are several important "factors" involved in this type of revisionary breast surgery. Most important (in my opinion): plastic surgeon experience level.     In other words, experience level and technical expertise play the biggest role when it comes to successful  outcomes with this type of revisionary breast surgery.   Careful attention to postoperative activity limitations as well as use of appropriate postoperative support of dressing/garments are also important.
 My general thoughts regarding the potential need for revisionary breast surgery:  I advise patients to carefully consider their degree of concern with the outcome of the initial breast surgery and weigh these concerns against the potential risks/complications associated with the planned revisionary breast surgery.   For example, if the patient is concerned about her breast appearance on a daily or frequent basis, it is likely that revisionary surgery will be helpful when it comes to improving her quality of life.  On the other hand, if the patient's degree of concern seems minor and/or she is  infrequently concerned about the areas of concern, I would recommend against revisionary breast surgery.Saline breast implants are usually filled within a range provided by the breast implant manufacturer. Utilizing saline volumes in the upper range of the manufacturer's recommendations helps cut down on concerns such as breast implant rippling. Sometimes, patients who are looking for a certain "round, fake look" benefit from the use of overfilled saline implants.  This involves filling the saline implants past the range provided by the manufacturer.
 I hope this helps.