Should I Be Concerned with Symmastia or Bottoming Out? 11.2 BWD Going from 375ccs Silicone to 500ccs?

I'm going to be having a redo breast augmentation to go a little larger. I am 5'4, 104lbs, BWD of 11.2. Currently I have round smooth Mento HP 375cc silcone under the muscle and want to go with the Allergan 45 style silcone super high profile 500ccs or 550ccs. Will I see enough of a size differnec from only 125cc increase and should I be concerned with symmastia or bottoming out? Thanks

Doctor Answers 7

Bottoming out and symmastia

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An implant change of 125cc will get you about a cup size. As the same pocket is being used bottoming out and symmastia should not occur. The most common cause for both of these problems is over dissection of the pocket.


Dr. Kearney

La Jolla Plastic Surgeon
5.0 out of 5 stars 32 reviews

Increasing breast size

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Good question. If you currently have 375 cc implants and they have not sagged or bottomed out, simply replacing them will 500 cc implants should not be a problem.Symmastia  is very unlikely also.  Whenever you have surgery of any kind, even a simple size change, there are always risks, but in your case the risks are small.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Symastia or Bottoming Out

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A 125 cc increase in implant size seems like a modest increase. If you already have bottoming out it could get worse without some pocket modification. Opening the pocket inferiorly at time of exchange could also promote bottoming out. Symastia usually occurs when trying to dissect the pocket too close to the midline and is an extremely rare occurance for an expereinced surgeon.

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Breast implant upsizing in a petite person

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Bigger is not always better.  From the information you have provided, it seems you are a petite person with a relatively narrow breast base.  The more the implant overwhelms the natural breast structure, the more likely you are to come back for repeat revisional breast surgery.  Large implants in a petite person thin out the natural breast structure, especially if the implants are under the breast gland and not under the pectoral muscle.

Seek the opinion of a highly experienced board-certified plastic surgeon.  If he or she recommends implants in this size range,  ask to see pictures of LONG TERM results at least one or two years out from surgery.  Make sure you think the result looks natural before proceeding with surgery.


I hope this helps.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Risks associated with large breast implants

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I can't help but be brutally honest with you. 

Large implants look great the first few years, but what is hardly mentioned is the multiple problems associated with them in the long run such as:

chronic pain

actual rib indentation (in your case because you are so thin)

descent of implant down your chest (not a pretty look)

stretched out/damaged skin and tissue, and

multiple need for revisions

It is a great money generating procedure for us, but not so much for patients.

Kind regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Possible complications related to increasing breast implant size

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I generally follow dimensional planning guidelines when performing breast augmentations, which include trying to match implant size to breast base width.  One concern is that disproportionately large implants may increase complication rates.

While it is impossible to be sure without seeing photos and/or a physical examination, your present implants are already wider than your base width - Mentor high profile 375cc implants have a base width of 12.0cm, compared with your stated base width of 11.2cm.  Allergan style 45 full profile implants have signficantly more projection (and weight) than your present implants, and the width of the 500cc implant is 11.9cm, while the 550cc implant is 12.4cm (even wider than your present implants).  You may be able to change to a higher profile implant, which will increase breast projection and look larger, while decreasing implant width.

Breast augmentation needs to be individualized to the patient.  I would recommend discussing your desire of a further increase in breast size vs. a potential increase in long term complication rates with your surgeon.

Good luck.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews

Synmastia or bottoming out with bigger implants

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If you currently do not have synmastia and your already formed implant pocket is not opened too aggressively medially the creation of synmastia is unlikely. As to bottoming out, if you haven't from your current implants it is unlikely you will with the addition of 125cc. Hope this helps!

Marcel Daniels, MD
Long Beach 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.