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

If you are having problems already with your breast implants falling into your armpits, adding more volume will make your situation worse.  I do not recommend larger implants.  If you want your breasts higher on the chest wall and more medial to increase your cleavage then I recommend explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

There is a recommended maximum fill volume for each implant. Mentor smooth wall 400cc moderate profile recommended maximum fill volume is 450cc. If they are moderate plus, or high profile, then the volume will be more, and the diameter will be smaller. You can put more than the recommended volume in, but it makes the implant more firm.The implants falling under your arms is most likely due to your scar capsule being too wide on the sides, and this can be corrected to stop that from happening. As far as natural cleavage look without a bra, your photo shows a very natural appearance. If you want more fullness superiorly, then the only real option is a bigger implant, and consider a more cohesive silicone implant which maintains more superior fullness.Good luck,Greg Sexton, M.D.Columbia, S.C.

Filling the implant makes it project more and become slightly more narrow. The implant can hold a lot of saline (some surgeons overfill implants by hundreds of cc’s), but the implant measurements won’t change more than about half an inch in either direction. If you have concerns about where your implants sit, you might have lateral displacement. This is where the pocket has stretched so the implants slide to the side when you lay down. It can be corrected, but it has more to do with moving your implants closer together than by filling them more. You could do both. I recommend discussing this with your original surgeon and seeking other consults if you aren’t sure you want to work with your surgeon  

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. 

You an overfill a saline implant by up to 20% from the size of the implant.  I would not advise opening up an implant that has been in position as yours have been and attempting this, however. A moderate style implant is made to be slightly wider than a high profile implant, and you have possibly had some lateral displacement as well with your current implants, particularly when you lay down.  Ask the advice of a highly qualified Plastic Surgeon in your area after a thorough examination before you proceed with changing out an implant, however.Good luck to you!Frank Rieger M.D. Tampa Plastic Surgeon