My surgeon suggest that I go with 600cc silicone implants and to be placed over the muscle. Thoughts? (photo)

From the photos that you have posted it appears that you lack some upper pole fullness and may require a slightly larger or higher profile implant but you also look like you have too much skin in the lower pole and lateral portion of your breast. I think that a revisional breast lift and implant exchange into the same sub-muscular, or dual plane pocket would be appropriate for you. You may also benefit from a biologic mesh placement for additional implant support. I do not recommend just a large implant over the muscle. Do NOT do that. 

Thank you for your question.  I wouldn't recommend going above the muscle.  Above the muscle implants don't typically last very long in my opinion.  It can make your breast droopy over time.  Going bigger with your implant isn't a bad decision and I would recommend a high profile implant.  I would suggest speaking with your surgeon and discussing all your options.  Best of luck to you. 

Hi, thank you for sharing your photos with us. Good question, I recommend you try placing correct size in your bra to have an idea of what a 600 cc would look like. I think for your body frame, if you like larger breasts, you will look beautiful!

To most accurately answer your question would require an examination and additional information. Of particular importance would be knowing if you generally satisfied with your overall size, or wanting to be bigger. From your photos, you have developed some recurrent ptosis over time . Revising your mastopexy alone should be able to correct the shape and provide a nice cosmetic result. If you are desiring to be significantly larger, you could exchange the implants at the same time, although In my opinion 650cc seems too large. I also would definitely not recommend repositioning implants over the muscle, as this interrupts a great deal of the blood supply to the breast, increases the incidence of capsule contracture and adds no significant benefit.

It's all about proportions.  Tall women with larger frames and broader chest, shoulders, and hips can often handle larger implants.   I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy.  Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision.  Any added weight to the breast will have a greater tendency over time to increase drooping; placing them under the muscle will help.
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

I have no problem with going to 600 cc's if you want to go to a larger cup size.  600 cc's sounds huge but it is just a big number.  Some people handle larger implants much better than others.  My issues concern re-positioning your implants to the subglandular position.  You already have a perfectly serviceable pocket under the muscle.  I don't know what purpose putting the implants above the muscle will serve.  You will lose some of the support of your implants if you go over the muscle (even more so if you go to a larger volume), you will be making a whole new pocket in previously un-traumatized tissue, and you will increase the risk of getting capsular contractures in the future.  I think I would stick to the submuscular position.  I would also recommend revising your previous breast lift procedure as that might be the best route to achieving more upper pole fullness.  You might want to get a second opinion from another board-certified plastic surgeon who can examine you in person and review your options with you.

600 cc implants weigh about 1 ½ lbs each and will make your situation worse.  Your breasts are already displacing laterally.  Since you had undergone such a massive weight loss I recommend a lift using The Bellesoma Method.  This technique reshapes your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained, if not injured during your previous surgery.  At this time, I recommend explantation using The Bellesoma Method.  Best Wishes,Gary Horndeski, M.D.

Thank you for submitting your photographs with a really important question.  600 cc silicone implants are very large and heavy for any patient that is placing the implant above the muscle.  This plan may not be the best for you as you are already experiencing breasts that are low and saggy.   I would recommend you seek another opinion from a board certified plastic surgeon.  Good luck.

We know that weight over time stretches skin. We know you have loss of skin strength due to weight loss. You have bottom heavy breasts already from photos. I can not think of a worse plan then 600cc implants above the muscle except for maybe 700cc, hope I made the point. From the other responses it is clear that a smaller below the muscle or dual plane implant with a skin tightening and shaping mastopexy to improve your shape is what I would recommend. Not only do above the muscle implants get hard much more frequently and interfere with mammograms they can end up like a rock in a sock in appearance which would likely happen to you. Please seek out advice from a board certified plastic surgeon.

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity. I recommend behind the muscle. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with. Finally, make sure your surgeon is a Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon