Would 625cc overfilled to 750ccs high-profile saline implant over muscle achieve my desired look? Suggestions please (Photo)

Question

I'm 5'7 180lbs and currently wearing a 38C or 36D. My desire cup size is 36 triple D. I don't want to get a lift due to my keloid prone skin. Last consultation I had, the Dr. advised me to get 650cc high-profile saline implant and overfill them between 725 to 750cc over the muscle to achiever my desired look. I want to look more on the fake side, as oppose to natural. I'm aware of my 2nd° sagging but I want to know if this suggestion will achieve something close to the wish picture I've posted?

Shlomo Widder, MD · Answer

Dear beauty,   Thanks for submitting your pictures and your goal pictures.  From observing your pictures, you appear to be C cup size with very large areolas, asymmetry (right much bigger than left) and ptosis level 2 , though the nipples are way bellow the fold.  With that presentation, if you were consulting with me, I would have refused to perform on you breasts augmentation only. The result will be grotesque, because the implants will be riding quite high , with the nipples way bellow the implants.    You are not going to look like your goal pictures !!!  To achieve a lift of the nipples without a mastopexy (surgical lift), the crease will have to be lowered dramatically, which will position your breasts very low on your chest, and that is very unattractive.   Another very likely high risk is that you will develop double bubble due to the stiffness of the crease (it is unpredictable), that will not stretch and stay as a band, creating the deformity that can be devastating.  As far as your fear from "kelloid" , many patients confuse hypertrophic scar(thick scar) with "kelloid" (scar that grows like a tumor, beyond the original wound). Many times, patients show me wide scar and call it "kelloid" , which obviously, it is not. Thick scar can be treated very efficiently with Kenalog (prednisolon) injection.   In regard to implants size. If indeed you are 36 D cup size, you will need 350 cc and 450 cc implants to become 36 DDD. If you are 36 C cup size(as I suspect), you will need 525 cc on the right side and 625 cc on the left side.   All these sizes are recommended, only, with full lift (key hole) procedure.  You have to realize, that not all result are the same, because experience, skills and aesthetic eye are critical for good and safe outcome. So, do your careful due diligence and choose wisely.       Always, consult with experience board certified plastic surgeons who do lots of breasts augmentation with full lift, in accredited surgery center for your safety. Most important, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage , perky, symmetrical and with fake or natural look as you wish.                            Best of luck,                                               Dr Widder

Gerald Minniti, MD, FACS · Answer

Hello,You would not look anything like those photos. You need a breast lift. How you scar on one part of your body does not determine how you will scar elsewhere.  In addition, the breast skin if very forgiving for incisions and scars. Go visit a few ABPS certified/ASAPS member surgeons that specialize in all aspects of cosmetic breast surgery.Best of luck!

Stuart A. Linder, MD, FACS · Answer

Placing a large overfilled saline implant above the muscle would be a bad idea. Although it may look nice for a very short time, it will sag terribly in a couple of weeks leading to more problems of skin laxity. You will need a full lift with Submuscular implants. Scarring is a serious consideration.

Larry S. Nichter, MD, MS, FACS · Answer

It is very difficult to determine 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 350 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. . 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 below link.#breastaugmentation#findingtherightsize#BA

Malcolm A. Lesavoy, MD, FACS · Answer

You are asking a difficult question, because you definitely have breast ptosis (sagging), and also asymmetry.  If those huge implants are used, your appearance will definitely look fake (as you wish), but your breast tissue will fall over the implants and you will have a "double bubble".  If I were your surgeon, I would not do it.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  I would caution you to be very careful with your decision-making; I think that is very unlikely that you will be displeased if you undergo breast augmentation surgery only. In my practice, I would offer you a breast augmentaion/lifting procedure, understanding that a second stage procedure would likely be necessary to achieve your size goals.  I would not offer you a breast augmentation procedure alone.  Again, please make your decisions carefully;  seek a few opinions from well experienced board certified plastic surgeons in your area  before doing so. I hope this, and the attached link (dedicated to larger breast augmentation surgery outcomes) helps.  Best wishes.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photos and question and like the other consultants I feel you would benefit from a lift to get close to the desired result and your keloid fears may be overblown.  So go on some complimentary consultations and look at photos of similar patients you may be surprised how good the scars look afterDr Corbin

Arian Mowlavi, MD, FACS (license on probation) · Answer

If you want to obtain the results you are seeking, you are going to have to accept a breast lift and implant augmentation procedure. Please consider a vertical mastopexy which will minimize tension around the areola and thus decrease risk of scarring.

Edward J. Domanskis, MD (in memoriam) · Answer

There afre several ways to get the fake look-either with overfilled saline implants, custom XL silicone implants or XL tissue custom expanders.It depends really on what cc size to want to get.
You can think of a saline implant as a balloon. The manufacturer recommends an overfill of about 20cc but they have been shown to be able to be filled much more than that. They do start loosing their shape and can significantly distort the appearance of your breasts. 
 I do overfill espcially since the FDA has restricted saline and silicone implants to a maximum saline shell size of 800cc and maximum silicone size of 800cc. I do not know why that number was picked arbitrarily. 
So, I do do breast reconstructions greater than that with XL tissue expanders which do pride a greater diameter and projection and upper pole fullness and allow the size to be adjusted either up or down. Also, the shell of the saline implants are very thin and can dreflate more easily. You may want to visit my site below which explains everything, esp for XL sizes which is my specialty, either initially or revisional surgery.

Would 625cc overfilled to 750ccs high-profile saline implant over muscle achieve my desired look? Suggestions please (Photo)

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