Is it safe to have an Implant exchange from 400cc to 800cc?

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), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

It's difficult to answer your questions without examining or seeing photos of your breasts.  It may be ok if you don't have a capsular contracture.  I recommend seeing a plastic surgeon to see if you're a good candidate for an implant exchange.

Dear Allie,    Posting front and side view pictures would have been helpful. Regardless of your questionable capsule contracture, you will need to have capsulotomy (scar release) in order to make room for the larger implants and create a natural looking breasts. Without the capsulotomy, your breasts will be too tight and possibly painful, and will have an unnatural look with fake cut off at the upper pole.   You did not provide your date of previous breasts augmentation surgery. I would recommend that you wait, at least, 4-6 months for the implants to settle and the capsule to mature.   The risk of capsule contracture is similar to your original surgery. To reduce the likelihood of capsule contracture formation, avoid  supplement , medication and foods  that thin the blood  2 weeks before and after surgery, perform implants displacement massage after surgery for 6-12 months, avoid strenuous activity for one month after surgery and take  one or two doses of antibiotics before any invasive procedure like deep dental cleaning, colonoscopy etc , to avoid implants' contamination with bacteria and development of  Biofilm.    Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                           Best of luck,                                          Dr Widder

Dear allie2_0,Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. 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 a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Picking an implant size is a very personal process. Without a proper examination it is impossible to determine the best procedure.  We recommend consulting with your surgeon to further discuss your concerns.

it would be best for an anterior capsulectomy (otomy if unable to remove like under the muscle) to allow your tissue to stretch unhindered over the larger, more projecting implant.  But be cautious of what you wish for as that is going big!  Capsulotomies alone could lead to contour irregularities so a capsulectomy is preferred in my opinion.  As for having to be double board certified, that is all hooey and just some marketing that surgeon is pushing... as double boards do not guarantee good outcomes.

Thank you for the question. Although it is not possible to provide you with definitive advice without an person evaluation, most patients are able to "go larger" at a second stage, once the breast tissues have expanded (after first-time breast augmentation). Sometimes, during this revisionary surgery, adjustment of the breast implant capsules is also necessary to achieve the desired outcome.   Yes, generally capsulotomy surgery is safe, assuming it is executed carefully.Exactly how much larger you can achieve during the revisionary breast surgery will depend mainly on your physical examination.  In other words, every patient's anatomic starting point will determine how large of a breast implant can be utilized safely, without causing complications.  The use of a larger breast implant (than what is safely "allowed" by the patient's anatomy) can be problematic;  potential problems include breast implant displacement/malpostion issues ( such as bottoming out, lateral displacement, symmastia...)  and/or significant breast implant rippling/palpability.
 
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 "one or two cup size increase" or "significant or noticeable change" 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.

Thank you for the wand I would go on some complimentary consultations with experts and recommendations after a full examination and discussion of desired results Dr Corbin

Dear Allie,Hello and thank you for your excellent question. Breast implant sizing is a combination of current versus desired breast size, chest wall and breast measurements, and skin and subcutaneous tissue quality. Depending on your chest dimensions, you may be a good candidate for the implant exchange that you are considering. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018

BeautyAdvisor Top Contributor

Without examining you, I can give you general guidelines.  Yes a capsulotomy will be necessary.  Your body frame, breast width and tissue laxity will be the determining factors as to whether you can accommodate an implant that large.  Best advice is to go to a very experience Plastic Surgeon.