I've read that using large implants could result in a wider scar. What size implants will worsen breast lift scars?

Question

I’d like to combine roughly 400cc implants with an anchor lift, but I’ve read that using large implants could result in wider scars. Does anyone know what constitutes “large”?

Eric Swanson, MD · Answer

You are fine having 400 cc implants. That's about average size in my practice. The anchor scar type of breast lift is not ideal. There is too much scarring and the breasts tend to look boxy. The vertical lift is better. I call it an "all seasons vertical augmentation mastopexy." Many plastic surgeons believe that large implants cause more complications, but in my experience this is not the case. In fact, surveys show that patients with larger implants tend to be more satisfied. Incidentally, tension does cause scars to spread but experienced surgeons know how to reduce skin tension by using deep sutures and minimizing skin tightness.

Luis M. Rios Jr., MD · Answer

Thanks for the question.Lot of patients come in thinking that if they are going to enhance their breasts, that they might as well go bigger to get their money's worth. It's not uncommon to hear "go big or go home."However big implants can create a whole set of problems. So, there is the other side to the story that patients need to understand. Here are a few thoughts for you.1) Big implants weigh more and are prone to sagging in the future.2) If you are needing a breast lift, more than likely you have lost some elasticity in your breast. A large implant will work against you.3) Women who need breast lifts usually have breast tissue, so a large enhancement is not necessary once the breasts have been lifted into a higher position.4) Studies show that implants in the low 300 cc range maintain their perkiness for a longer period of time.5) Determining proper implant size involves measuring your breast width in order to find an appropriate implant that will give you enough cleavage.6) During a breast lift, the breast is lifted and tightened. Putting a large implant is working against the concepts of a breast lift.7) 3D computer imaging can help you visualize a breast lift with different sizes of implants before you actually do the surgery.The main point here, is that most Board Certified Plastic Surgeons consider implants above 400cc's to be big, especially for a breast lift. If you can be happy with an implant with a proper breast width in the 300cc range, your results will have a better chance of lasting for a long period of time.Good Luck and choose wisely!

Daniel Barrett, MD · Answer

Dear yenelili,
breast implant are frequently used in a combination with breast lift. My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. 
If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Cain R. Linville, MD, FACS · Answer

An implant that is too large for the skin volume will cause stretch and pressure, and thus result in a scar that tends to widen, or in worst case scenario, open up.  So, there's no set answer, which is why you won't see it anywhere, but 400 is probably ok.  Now, if I or the PS were to make the lift/reduction too small and shrink the skin envelope, and then try to stuff a large implant in (relative to that size), then yes, it could cause widening.  There is a very fine balance.

Tom J. Pousti, MD · Answer

Thank you for the thoughtful question.    There is no uniformly accepted "large" breast implant. As you can imagine, what may be too large for one patient (for example small framed) may be just right for a wider framed patient.   Also, there are many variables, besides the size of breast implant utilized, that will determine exactly how a patient scars with breast lifting surgery.Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
  As you have noted, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars and/or implant exposure. .
 
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work. 
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. The use of computer imaging may be very helpful during this communication phase.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of the tailor tacking technique and the use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
Best wishes.

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