Is 650cc saline too big? Can they cause complications? I'm 26 year old, 5'7 and 170lbs. (photos)

I appreciate your question!

After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon 

#RealSelf100Surgeon

#RealSelfCORESurgeon

It is very difficult to determine the best sizeyou will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implant
#toobig #breastimplant

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  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 Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Thank you for your question. Based on your photos, you appear to have a nice starting place and should have a nice result with breast augmentation surgery. I think that 650cc implants are large and do cause future complications. The most important factor when sizing implants, is working closely with your surgeon in person to find the implant size that gives you the look that you desire. Careful measurements of your breast and chest wall will help determine which size implants will fit within your natural breast footprint. Taking into account your desired look, and your measurements, an implant is chosen that specifically fits your body. Unfortunately, online recommendations are not that helpful. Make sure that you have a good relationship with your plastic surgeon, so that you two can work together to find the right size. In my office, patients try on implants in a bra and clothing. There able to see how they look in the mirror, and in photographs. Women are also encouraged to bring in wish pictures, so that I can get a sense of the look that they would like to achieve. Good luck with the process!

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  650cc is a large implant.  The size, profile, and shape of
the implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Even though you are taller than average, 650 cc's is still a large implant. I would suggest that you discuss the risks of a larger implant with your surgeon, since he or she is able to assess your tissues. Good luck!

Hi cecyap21,

Breast implant type and size selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion of the pros and cons of the various types and sizes. 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 your plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery 

Member, American Society of Plastic Surgery

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.

It is true that heavier implants stretch the muscle and skin more, and may bottom out more easily due to weight, especially in patients with skin laxity. An in-person consultation allows us to take measurements and inspect the skin laxity for the ability to take a larger implant. Note that you have some asymmetry of your breast hang on the two sides and this would be addressed in the discussion as to what options we have for improving the symmetry with and without a small lift.As for implant style and size, often the widest implant that fits the patient's base diameter and is within the volume range the patient seeks would be best; if a patient selects an unnecessarily narrow or excessively high profile implant, she may end up with wide cleavage or implants that can move too much in the pocket. However, it also depends on the type of projection being sought. In general, implant volume is determined by a combination of estimating the patient's own breast volume and the target cup sizes, and determining a range of added cc's of volume that would be expected to achieve the goal. Implants come in a variety of "profiles," which is a term that describes how much of the volume is used to create width vs. forward projection of the breast. Moderate profile implants are wider and flatter, while high and ultra high profile implants are narrower and taller, and "moderate plus" implants are somewhere in between. A patient with a very narrow chest wall and little native breast tissue is often a good candidate for a high profile implant, whereas patients with a lot of native breast tissue and a wide chest may do better with a moderate or moderate plus implants style. 
During consultation, your surgeon will take breast measurements including the chest wall, and will look at whether you need a lift, areola reduction, or other approaches, as these can also impact the implant size that will give you the best result. 
There is no "cookie-cutter" approach to sizing for breast implants to achieve a "natural" look, or even a "done" look. Because breasts have significant variability, depending on native breast volume, shape, nipple position, descent (or "sag"), and symmetry issues, what one patient considers natural may differ from another patient's perception. It is therefore very important to try to explain your cosmetic goals to your plastic surgeon during your consultation.
Pictures of models illustrating your ideal breast appearance can be helpful, but be careful not to assume that there is any guarantee of getting the exact same look. Many patients who end up with an "unnatural" look do so because of poor communication regarding their goals preoperatively. But there are also intraoperative and some postoperative factors that can contribute to the appearance. The dissection of the implant pocket by the surgeon is the most "controllable" factor in determining the final appearance. Using overly large implants for the patient's chest wall measurements can contribute to an unnatural outcome. In addition, the placement of implants over the muscle may make them more visible and detectable, particularly in patients with relatively small preoperative breast volume. The surgeon must take care to make a well designed pocket for the implant - not too spacious, and not too tight - and this step is often aided by careful preoperative marking and review of photographs.
Because of these variables, we use surgical simulation software (Crisalix) in the office to simulate the effects of different styles, sizes, manufacturers, and even positions of the implants, which helps take a lot of guesswork out. This is typically combined with the use of a sizing kit designed by the implant manufacturer. The kit has a variety of inserts that the patient can put into her bra or into a tight fitting top to simulate the effect of augmentation with various-sized implants. When combined with simulation software, this helps us agree on implant size, style, manufacturer, and other variables. We rarely have to revise our own breast augmentation patients for size as a result of this careful planning. However, we are often called on to perform revision breast augmentation on patients who had surgery elsewhere. 

Thank you for your questions and photos. Determination of breast implant size and shape can only be done after a detailed examination. In general, large breast implants have been associated with premature sagging, soft tissue thinning and possibly a higher incidence of nipple sensory loss. Please consult with an experienced board certified plastic surgeon to learn about your breast implant options.