What are some of the long-term effects of XL implants, if any?

Larger implants can lead to increased skin stretch, but that is not the only factor at play here. Genetics, native skin stretch, shape and weight of existing breasts and fluctuations in weight all contribute. Just because someone has larger implants, doesn't automatically mean they will have sagging breasts in the future.  I have found that women with a taller frame and broader shoulders can handle a larger implant for the right look. A certain sized implant that might look great on you might look way too large on a 5'1" friend who weighs 100lbs.  Objective measurements can be done to help ensure the right implant is chosen for the right individual. By trusting a board certified plastic surgeon, you will have the best chance of obtaining your desired results. Good Luck.

The goal of breast surgery is to create beautiful
breasts. Beauty is determined by several
factors and women often confuse breast volume with projection. As patients go to larger implants, the increase
in projection diminishes. For example,
the Sientra textured high projection implant that is 565 cc’s has 5.5
centimeters of anterior projection. An implant
half that size (approximately 300 cc’s) has 4.6 centimeters of anterior
projection. The difference is 0.9
centimeters, which is about 3/8th of an inch. A 3/8th of an inch increased
projection would not be noticeable on any patient even though the implant size
has doubled. A larger implant will not
give significant projection. Since you
have great breast tissue I recommend The Mini Ultimate Breast LiftTM
to reshape your breast creating upper pole fullness, elevate them higher on the
chest wall and more medial to increase your cleavage. Smaller implants are more stable long term,
less likely to displace inferiorly and laterally requiring revision. 22% of women who undergo breast augmentation
require a revision within 2 years because of dissatisfaction with the
results. Larger implants, such as you
have suggested, increases the probability of revision. Best Wishes,Gary Horndeski, M.D.

In general, implants that appear to be larger than natural will tend to have a higher risk of bottoming out, implant malposition, gradual thinning of your natural breast tissue, rippling, implant palpability, and future need for revision including mastopexy. That does not mean that if you end up having 600-700 cc implants placed, that you will certainly end up having problems. It just means that your risk of having these problems will be higher than if you choose an implant size that is more natural for your body frame. There are certainly patients that can do very well with large implants. And if you are starting with healthy skin, some native breast tissue, and a frame that can handle the volume, you might not have any problems at all. Bigger is not always better. But you should trust your surgeon and feel confident that he/she is not leading you in a risky direction.  

Based on some significant experience with a large number of patients who have undergone breast augmentation with “larger” breast implants, I do not necessarily think that it is the size of the breast implant that causes problems but the selection of a breast implant size that is TOO LARGE  for a specific patient's anatomy to accommodate. Utilizing a breast implant that is too large for a specific patient's anatomy exposes the patient to potential problems with breast implants displacement ( such as bottoming out), breast implant rippling/palpability… I hope this, and the attached link ( dedicated to “larger” breast implants) helps.

Because of the weight of the XL implants, they tend to sag more and sooner so XL patients should always wear supportive bras. Also, neck/back pain is a real possibility. 

It is true that excessively large implants can cause problems such as rippling, drooping and uniboob. That said, larger implants that are not too large for your body usually do not have higher complication rates. I frequently use implants as large as 800 cc. In the right patient, they work fine. Seek a plastic surgeon who is certified by the
American Board of Plastic Surgery who specializes in cosmetic plastic surgery,
as evidenced by membership in The American Society for Aesthetic Plastic
Surgery. Ask to see many pre and post op photos and speak with previous
patients. Don’t let price be your sole determinate. The type of surgery you are
describing takes some real expertise. If you have surgery and have to have it
redone, it is no bargain.

The following are factors that can make a difference in the long-term:The proper fitting of the implants to your frame, correlating measurements of your breast and chest to find implants that will fit you best.The amount of natural breast tissue relative to the size of the implants.The tone of your skin and breast tissues (elasticity).How your body (tissues) age.It is true that larger breasts (with or without implants) may be more likely to droop with aging, but skin elasticity, genetics, and hormone changes also play a role.None of us can guarantee that an individual patient will never have future problems such as downward or lateral drifting of the implants, ability to feel or see the edge of the implant, rippling or drooping.  Your Plastic Surgeon's assessment of your frame and tissues and his her judgment are critical to your considerations of obtaining the results and longevity you seek.