Dangers and Risks of Large Breast Implants?

Question

I am 5'6" and 145lbs. Is 650cc HP saline too big? I am currently a 34B and I'd like to have a 34DD breasts. I really don't want to go bigger than that. Also, are there any risks or dangers with having a large implant?

Brent Moelleken, MD · Answer

When large implants are placed, predictable and bad changes occur, causing problems that may be unfixable.
The large implants require large dissection underneath the muscle (or worse under the breast).  This creates a large "pocket".
Skin thins; it is just doing what it is told when a large foreign object is placed- thin out!  Implants can actually protrude from the skin.
Nipples are much more likely to become numb from surgery.
Droopiness occurs much more quickly, requiring breast lifts in the future.
Revisional breast surgery in patients who have had very large implants in the past is very risky for complications, even in the best of hands.
The chance of revision surgery is much higher.  The results of that revision surgery are far worse than for normal size implants.  The internal pocket is simply huge, and the existing techniques for reducing the size of those capsules are weak. 
The implant can erode into the ribs, causing a change in their shape.
The implants are no longer hidden by the natural breast tissue.  They ripple more and show more, and are more palpable.  Increased risk of loss of nipple sensation. 
A double bubble problem can occur, where the implant and the silhouette of the old breast are simultaneously visible.
They can have the unintended consequence of making patients look "matronly" .
Stretch marks are common and untreatable.
If a pocket is made that is large, the muscle is often removed from the chest bone (sternum) and "jumps" when it is used.  This problem is not usually fixable.
It is not uncommon to see women who have spent $60,000 plus total on their breasts after several revisional surgeries, and still don't look good.
Large implants are not a good idea.

Antoine A. Hallak, MD, FACS · Answer

Hi, the general consensus is that anything over 450-500 starts to be considered a large implant and a 650 is a significantly large and heavy implant especially with saline.
	large implants have associated downsides like faster sagging and more skin thinning over time, not to mention weight. based on your height and weight, you can probably achieve your goal with a smaller silicone implant, but without a formal consultation by a qualified surgeon it is impossible to give accurate advise.

Shahram Salemy, MD, FACS · Answer

GIven your description of your frame, I would recommend a smaller sized implant, perhaps in the 400-500 cc range, to give you a dramatic improvement without overstretching your tissues.  Once these tissues have been stretched out by very large implants, I think it is difficult to maintain a natural look to your breasts.  Also, as you get a little older the tissues will thin, and then if you want to downsize the implants a bit, it will be very difficult to do so without adding the additional scars of a breast lift.  If however you decide later on that you want to be a bit fuller, it is easy to do so through your existing incision without adding new ones.
In general, I advise my patients to be a bit more conservative than what you're describing.  In the end, however, it's your body and your choice, as long as you and your surgeon have an honest discussion about the pros and cons of the implant choice, and you are willing to accept the possible risks.

Otto Joseph Placik, MD · Answer

Yes, this is a larger than average breast implant.
There are numerous increased risks associated with this, and I am sure I will not even touch on half of them, but consider the following.
The size of the implant has been associated with:

Increased risk of loss of nipple sensation
Increased risk for long term breast ptosis (sagging)
Increased risk for chest wall deformation (curving of the ribs)
Increased risk of rippling or palpable /visible creases
Increased risk of lower pole tissue attenuation (thinning of the tissues of the breast)
Increased risk of secondary revisionary procedures

These are a few of the risks off the top of my head. Please discuss with your surgeon.
Most importantly, remember that although you are seeking breast enlargement, many women present complaining of breast overgrowth desiring breast reduction. These women report limited physical activity, neck/back/shoulder pain, shoulder grooving from bra straps, numbness in the fingers, rashes beneath the breasts, etc. 
Many of these women feel significant relief with reductions as small as 300 cc yet you are considering adding twice that to your breasts. Think it over carefully.
I hope this helps.

Tom J. Pousti, MD · Answer

Thank you for the question. Yes, larger breast implants can be problematic (more so than smaller breast implants), both physically and psychosocially. Therefore, careful patient selection is key. On the other hand, some of my happiest and most grateful patients, our patients with “extra large” breast augmentation surgery. You may find the attached link, dedicated to “extra large” breast augmentation concerns, helpful to you as you learn more. Best wishes.

John P. Di Saia, MD · Answer

Hello, 
There are risks that occur more frequently with larger implants. The visibility of the implants through the tissues is more likely and the need for re-operation over the short term is increased as well. Distortion can be hard to correct when you go really large and the tissue can have a harder time handling the implants. I commonly discuss these issues with ladies looking into larger implants.
I would suggest targeting a mid to large D size at first to split the difference in risk and size. It is of course your call how you might proceed.

Robin T.W. Yuan, MD · Answer

Ideally, you should have implants that fit the dimensions of your breast tissue. As you go larger, there are numerous risks and side effects that increase. Because the dissection required is often greater in order to accommodate a larger implant, sensory changes such as numbness of the nipple can be more frequent. If your soft tissues are tight, a large implant will feel harder (pure physics problem).Longer-term complication include soft tissue compression and atrophy whereby the permanent implants compresses the soft tissue (the more pressure needed to stretch the tissues to a larger size, the more pressure exerted on the soft tissues between the implant and the skin) with thinning and, in some case, extrusiuon or near-extrusion. Similarly, the weight and pressure of large implants can cause remodeling of the underlying ribs. Also, remember that volume means weight and 650cc in each breast means about 1 1/2 pounds on each side of the chest. Many women with DD breasts are getting reductions because of the symptoms relating to excessive weight. There are always going to be trade-offs in cosmetic enhancement.

William B. Rosenblatt, MD · Answer

I personally thing that big implants look ugly. But it is your body - although there may be some slightly increased problems with larger implants, this is an individual decision that you and your plastic surgeon have to discuss and decide upon. Remember this is surgery, not a beauty parlor visit. 
Take your time and think about it and do the rice trick - use a measuring cup with ml or cc on it and take 650cc of rice - put it in a stocking or baggie and put it in your bra. This will give you a rough idea of the size. Do this on both sides and put clothing on and see how you look - after that it is your decision. 
Be informed - ask your surgeon questions and have them answered.

Hisham Seify, MD, PhD, FACS · Answer

Choosing the ultimate size implant is one of the most important decisions. Several factors contribute to that proper range of sizes:
1-The breast and chest wall dimensions.
2-The amount of skin and soft tissue available to cover the implant.
3-The relative location of the nipple,fold in relation to the chest wall.
During your consultation with a board certified plastic surgeon all these factors will be evaluated and a healthy range of sizes will be advised based on the patient request for size increase.
Your 650ccHP saline will be inflated to at least 700 per the implant company recommendations. This is a very large implant. In patients with very little breast tissue (A Cup) this could be what it takes to reach a D cup. In general it is hard to expect a natural look in this situation.
Large implants have their problems e.g over stretch of the breast tissue and the skin, possible implant malposition and later drooping etc.
Every patient is different but in every case I do, I observe while the implant is getting filled and there is always a great natural breast shape achieved with moderate size implants. Hope that helps!

Bruce K. Barach, MD (retired) · Answer

Just like "real" large breasts, breasts that are augmented to that size will likely become saggy over the years, so you might be creating a problem that is difficult to fix. 
While you may like the look of the larger breasts in the short run, you probably won't like how they look in ten years. I suggest you compromise a bit on the size now so you avoid trouble down the line.

Dangers and Risks of Large Breast Implants?

Answers (12)

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