Implant exchange. 375cc to 550/600 cc. Good idea?

Question

I'm a 140 lb, 5'4" tall female with high profile 375cc silicone implants. I started with a small A cup and currently im a full B/small C. Im having a TT soon and considering an implant exchange. I'm thinking of 550cc or 600cc moderate plus. Would this be a good idea? What complications would I be facing with bigger implants? I want a bigger/fuller look but I'm truly worried. My new plastic surgeon thought my implants were 325cc, that's how small they currently look.

Richard Baxter, MD · Answer

If you already have high profile implants, then this suggests that your surgeon chose that profile as the best match to the base diameter of your breasts; if so, that would mean that going to a less projecting profile like moderate plus would widen the breasts too much. The risks of larger implants include bottoming out because they are heavier, and visible rippling due to stretch and thinning. Your decision needs to be made with guidance based on your breast measurements and in-person exam.

Urmen Desai, MD, MPH, FACS · Answer

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

Daniel Barrett, MD · Answer

Dear CaliiGal26,Determining the ideal breast size and matching that goal for the patient is the most difficult part of breast augmentation. It starts and ends with the patient. 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 its 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, everyone of them have 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.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Farbod Esmailian, MD · Answer

Going from a high profile implant which likely fits your base diameter well to a larger implant would likely require a bit of capsule work to open things up a bit.  You may be able to go larger, an exam would be appropriate to see how much larger you can go, but to go to a moderate plus implant of 550-600 cc would be tremendously wider than your breast width.  You would probably want to be looking at high profile or ultra high profile if you are looking at that large of a cc.Again, it is possible but an exam would be necessary to see what would be ideal.  Going beyond your measurements will just lead to problems, in particular rippling, in the future.Hope that helps.

Curtis Wong, MD · Answer

can always be done but when you ask about risks, you are accepting all of the risks all over again, especially for contractures if you are contracture free right now.  But if you're really wanting to go larger, doing it at the time of your tummy tuck makes a lot of sense so discuss this with your surgeon and assuming there is a profile that will work for you, go for it!

Tim Sayed, MD, MBA, FACS · Answer

Hello,Thanks for the question. It is very difficult to give you any input without photos and an examination. A surgeon would need to measure the breast diameter, compare it to your prior implant specs and the ranges of implants you are considering, and assess for things like skin thickness, laxity of the tissues, native breast volume, breastbone width, etc.Sometimes simulation software can help, because we can simulate the effect of "subtracting" the existing implant volume from the breast and then adding the new planned implant. However, there is always some surgeon judgment required in the operating room in order to balance the implant with your chest diameter, tissues, and other factors. An in-person exam is best.

Malcolm A. Lesavoy, MD, FACS · Answer

The size of the implant for a fuller look really depends on the envelope of breast tissue you have naturally.  After your first augmentation, I assume your tissues have stretched somewhat, and now can accommodate a larger implant.

Tom J. Pousti, MD · Answer

Thank you for the question. You will find that online consultants will not be able to provide you with specific advice in regards to selection of specific breast implant size/profile.  Adjustment of the breast implant capsules may also be necessary.
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical. 
Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation 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. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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 "D or DD cup” or "bigger/fuller look" 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. 
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 ( after the use of temporary intraoperative sizers). Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select the best breast implant size/profile for the specific patient.
I hope this helps. Best wishes.

Lynn D. Derby, MD (retired) · Answer

Changing to larger implants is one of the most frequent revisions in breast augmentation.  When properly planned, the procedure can be as safe as the original augmentation surgery, but there are some important considerations.  The implant needs to have a base "footprint" that fits your rib cage or it could give excessive side bulging.  You need to have enough healthy tissue to cover the implant or the outline could be visible through the skin.  Your tissues need to be strong enough to hold up the implant, or there could be premature sagging.  It is dangerous to go so big that the incision is closed under excessive tension, which could lead to wound breakdown and implant extrusion.  These things can only be determined in person with a physical examination.  Have you discussed it with your plastic surgeon yet?

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