Is it common for doctors to "overfill" breast implants?

I have been researching both breast augmentation and breast implant removal boards and one thing I have noticed among the removal patients is that a lot of them were unhappy with their size (too large) because the PS overfilled implants that they had agreed during consultation would be a certain size - and then the PS made them much bigger. I'm worried this could happen to me, because I'm a very small person and I don't want huge boobs.

Doctor Answers 16

Overfilling breast implants

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You actually raise two really good questions:

The first is, "Is it a good idea to overfill implants?" I'm assuming you mean saline implants because those are the only ones that are filled on the table.

The idea behind overfilling saline is to decrease rippling and possibly extend the life of the implant. It works. But not particularly well and at a cost. Overfilling the implant will somewhat reduce rippling - though not completely -  unless you overfill by an absurd amount. Not a good idea because even some overfill will make your breast feel harder than you may want.

If you're really concerned with rippling, you should strongly consider using silicone gel implants instead of saline. That's the single best move you can make. If you're dead set on saline, there are several things you can do that will be better than overfilling:

1. Use a smooth implant. Smooth ripples less than textured.
2. Put the implant under the muscle. More padding = less rippling.
3. Put in an implant that fits your breast. This is the critical one! Overly large implants will push outward on your breasts day after day after day. They will eventually thin your breast tissue and more rippling will show. Most really bad rippling happens in women with huge implants.

Your second question is, "How do I avoid ending up with breasts that are too big?" (I paraphrased a little.) This one isn't likely to happen from your surgeon overfilling the implants. But it can happen if your surgeon puts in the wrong size implants. This problem originates in the consultation, not in the O.R. You need to find a plastic surgeon with whom you can communicate well. He needs to listen and hear exactly what it is you want. He also needs an effective method to ensure that both of you go to surgery with the same image of what your breasts are to look like. Discussing cup sizes does not work for this purpose. Putting implants in your bra does not work. The best systems use photographic review and/or imaging software. Whichever system your plastic surgeon uses, you both need to be be on the same page going into surgery. If you are not, you're not likely to get the breasts you want. 

Richardson Plastic Surgeon
4.7 out of 5 stars 16 reviews

It’s common but you may not notice the difference.

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Manufacturers provide guidelines for how much saline should be added once the breast implant has been placed. For the best results, you want to get the amount of saline just right. Too little and the possibility of rippling increases and you may not see the desired projection. Too much to the point of excess and you may void the warranty and make the breast implants feel too firm. Thus, plastic surgeons tend to overfill by 5 to 15 percent to find that happy medium. 

Ricardo A. Meade, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 125 reviews

Choosing implant size

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Hello and thanks for posting your question on RealSelf.
Choosing implant size is unique to each patient and a lot more attention has been paid to it in the past 5-7 years. With silicone implants the size that we discuss at the consultation will not change in the operating room-because the implant is prefilled. With saline implants, the surgeon fills the implant in the operating room, thus the discussion changes to a range of volume that the chosen implant will hold, ex 325-345cc. Overfilling beyond the manufacturers guidelines is not advisable.
You should choose a reputable plastic surgeon whom you trust and feel that you communicate well with. Open discussions and asking these questions of your surgeon will ultimately lead to a better result.

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I always discuss the specific size with my patients prior to surgery, so they have no surprises afterwards. Sometimes, a size range is discussed, and the patient knows I will make the final decision in the operating room. However, the basic size has been chosen prior.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 reviews

Saline Breast Implants

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With saline breast implants it is common practice to overfill the base volume to some degree. This is done because it lowers the risk of subsequent saline implant failure due to fracture of the shell. But at most this is 50ccs or so which does not add any appreciable breast size increase in most cases.

Selection of breast implant sizes.

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Good question.  There are two possible meanings of overfilling here.  The first is overfilling saline implants to decrease (slightly) rippling potential.  A little is perfectly okay as long as it's not done to excess.
The other and bigger issue is when too large an implant for the available tissue, skin and breast distensability is placed.  This should be avoided by the doctor and patient agreeing on an approximate breast size and contour recognizing that the best method for implant selection is by the surgeon choosing based on actually visualizing the size and contour during the surgery using a test implant or sizer.  Most surgeons can approximate very accurately about 90 percent of the time however despite measurements and experience about 10% of the time a slightly larger or smaller implant proves to be idea.  There should not however be any giant surprises as you suggest.  You'll learn some more from the video above.  Please review it.
Be sure that you are confident and trust your plastic surgeon to achieve as close to your goal as possible or find a different doctor.
Good luck and enjoy your results.

Jon A Perlman MD FACS
Certified, American Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Best of Los Angeles Award 2015, 2016
Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews


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An important part of the process is do discuss with you surgeon what you want. The goals of the patient are key!

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Filling volumes for saline implants should be discussed before your operation.

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Glad to hear that you are reading in preparation for your enlargement surgery.   Plastic surgeons may approach breast volume selection for their patients in a number of ways.  We have our patients estimate their new breast volumes with sizer implants in bras.  Size is limited by tissue, social, and measurement factors.

When we use saline implants, the filled end volume is the volume selected by the patient. This can be altered somewhat to create symmetry in the operating room. Therefore, the actual implant size used would be less than your target volume. It then is over-filled up to your selected volume.  It is rare to require volumes above what our patients select in the office.   Overfilling may reduce rippling with saline implants.

Hope this answers your question.

Best Regards,

Douglas J. Raskin, MD
Colorado Springs Plastic Surgeon
4.9 out of 5 stars 69 reviews

Implant fills

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should be agreed upon PRIOR to your procedure.  As for overfilling, some doctors do that but it theoretically voids the warranty so this should always be discussed at length with patients if an overfill (beyond the normal fill volumes) prior to the procedure to ensure the patient is accepting of that concept.  If you're allowing your surgeon to pick the size for you, I would ask why?  My patients ALWAYS choose the size they want and that is what they get.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Are Breast Implants Overfilled?

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Thank you for your question.  Both saline and silicone implants are FDA approved for Breast Augmentation. Both achieve excellent results.  Silicone are pre filled and therefore have a set/fixed volume.  Saline implants need to be filled at the time of surgery.  Commonly, the implants are filled to the upper range of manufacturer suggestion which is termed "overfill".  This typically amounts to about  1 tablespoon of saline.  We may say 30CC, but that equals one tablespoon which is not a lot.  It is important to discuss your goals with your PS making it unlikely that your expectations will not be met.  Good Luck,
Beverly Friedlander, MD 

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 19 reviews

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.