Implant size under the muscle with lift - is 350cc the largest I can go for a good result? (Photo)

Question

I am 5”10 and weight 12stone 8lbs i had a breast enlargement 10 years ago i had 550 hp over the muscle implants since this time i have lost a lot of weight so my breasts are now extremely saggy so I need a reaugmentation with a full lift, my consultant has suggested removing the implant due to lots of rippling and displacement and removing the capsule and replacing with new implants under the muscle in a new pocket with a mastopexy My question is he will not go bigger than a 350cc hp implant as he said it’s under the muscle and cannot put bigger but can at a later date and I am worried this is to small or is this the only option for a good result

Daniel Barrett, MD · Answer

Dear Boston30,

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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mehmet Ozdemir, MD · Answer

Moving from a 550cc over-the-muscle implant to a 350cc under-the-muscle (UTM) placement is a significant change, but your surgeon’s caution likely stems from the complexity of performing a full mastopexy (lift) at the same time. When switching to a UTM pocket, the muscle provides better coverage to fix the rippling you’ve experienced, but it also creates more internal pressure; combining that pressure with a very large implant can compromise the blood supply to the skin and nipples during a lift, increasing the risk of "bottoming out" or poor wound healing. While 350cc might feel small compared to your previous size, a high-profile implant combined with the tightening of a lift often results in a much perkier, more "filled-out" look than saggy, larger implants. If your heart is set on maintaining more volume, you could discuss using Internal Bra techniques (like Galaflex mesh) or a two-stage approach doing the lift and pocket swap now, then potentially exchanging for a larger volume once your tissues have healed and stabilized.

Implant size under the muscle with lift - is 350cc the largest I can go for a good result? (Photo)

Answers (2)

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