Does having implants wider than your breast base width pose any increased long term risks?

Question

Hi Doctors Previous doctor replies have explained going wider than your diameter gives a more fake look & "side breast" fullness. I would specifically like to know about long term effects if I go with an implant wider than my breast 1) Will the sides of the implant be palpable or will it still be covered by breast tissue? 2) Will it cause more damage to my breast tissue in the long term because I went wider than my actual breast or is the risk just the same as a smaller size? Thanks Kim

Eugene Kim, MD · Answer

Thanks for your inquiry.  Every doctor has different ways to assess
their patients and choose the right implant sizes.  It is not uncommon to have 3 different
measurements from 3 different plastic surgeons. 
Some doctors are very diligent about sticking to the numbers of the base
width diameter and others a little bit more liberal with it.  So, I would not focus on the actual numbers,
I would focus more on the results you are looking for and whether or not your
doctor can achieve those results.  One
way to do this is to look at the doctor’s before and after photos and find
photos that are similar to your build. 
Then, look for results that look similar to what you want.  I hope this helps.

Jaime S. Schwartz, MD, FACS · Answer

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. Implants that are wider than this can be more palpable, fall more laterally overtime and also be more palpable. After that we will then choose the implant volume based on the measurements and also looking at any asymmetries you might have. 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 peoples bodies and your results will probably be different.
Silicone will give you a 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 more 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, are 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 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

Michael R. Schwartz, MD · Answer

The goal in Breast Augmentation today is to respect the natural diameter of your breast.  When I advise patients about this. I want to stay within one centimeter of your starting point.  Sometimes a very narrow or unusually shaped breast needs a more aggressive approach.  If you stretch the base diameter more than this, there is increased risk of tissue damage as you asked.  The results would include a more visible implant, an implant edge that would be easier to feel, wrinkling, rippling, loss of nipple sensation, and even implant position problems.  Many of these are not correctable and must be avoided.  
Please be sure to consult with a Board Certified Plastic Surgeon to discuss your options.
Best of luck in your research
Dr. Schwartz

Andre Aboolian, MD · Answer

You don't want to do that because: 1. it will not look natural, 2. you will feel the implants on the sides, 3. you will most likely see the rippling even with silicone implants all becasue there is no muscle there.  Review the before/after photos of the surgeons you are interested in to see if you like their results. Good luck, Andre Aboolian Beverly Hills Plastic Surgeon

Tim Sayed, MD, MBA, FACS · Answer

Good question and well stated. The need for wider implants than your breast width may be dictated by a wide gap between the breasts, your volume goals, prior surgery and capsules, and other considerations. There is some risk with particularly large implants that they may "splay" out to the side of the breasts/underarm area when you lie flat over time. There is always a bit of a trade off between volume of the implant, width of the breast, and where the natural curves of the preoperative breast fall. We use Crisalix software to try to help figure out the right balance of implant technique, style, size, etc. with the patient and I believe it is a great tool for patient education and level setting for expectations.

Curtis Wong, MD · Answer

is necessary in many situations when patients have certain expectations so patient goals will dictate if my implant selection will exceed their natural breast width.  If you have a wide space between the mounds (aka Death Valley) or narrow breasts and side boob is wanted, wider implants will have to be used.  Risks of dropping your fold in such situations mean accepting the chance you could have a double bubble and bottoming out down the road.  So each patients implant size is individualized for what the anatomy is and what the goals are... and if you have a surgeon that absolutely refuses to exceed your natural width when you really need to, you're best off finding another surgeon.

Parviz Goshtasby, MD, FACS · Answer

Hello 'kimhalcro', thanks for your questions.  Ideally you would want implant widths that match your chest wall in order to achieve the most harmonious look.  Occasionally this cannot happen, which typically occurs when patients request a significant augmentation in relation to their body habitus.  For instance, someone with a petite frame who wants to become a D cup or larger will likely require an implant with a larger base than their frames will allow because quite simply they do not make implants with those dimensions.  As for your questions: 1) Yes, the implant sides will typically become more palpable with the wider implant sizes and the less natural breast tissue that is available.  However, this is usually not an issue if you use silicone implants that feel natural.  The problem occurs when the rippling of the edges of these implants become visible at the sides of the breast.  2) I am not sure what you mean by 'damage'.  The breast tissue will become more stretched out with time and gravity depending on greater volumes of the implants, but this would be true regardless of implant width.One final thing I will mention is that using implants wider than your chest anatomy does lead to an increased risk of synmastia, which is where the implant stretch the midline cleavage, and in extreme cases can tear into the other pocket, giving the impression of one breast pocket with loss of cleavage.  Thus, it is recommended that you speak with a board-certified plastic surgeon to choose the best implant fit for you.  If you would like to discuss this further to help you achieve your goals, please contact my office for a complimentary consultation.  Good luck!-Dr.Go

Marcel Daniels, MD · Answer

Having implants wider than your natural breast width may also put you at increased risk for lateral displacement issues (especially when lying down) as the natural attachments to the chest wall have been attenuated. Get at least a couple of in-person opinions from experienced breast surgeons who canhelp you pick the right implant for you. Hope this helps, good luck!

Michael C. Edwards, MD, FACS · Answer

In general your implant(s) should be close to your natural base width. That having been said there are times when you may go a little wider to carefully try to fill out a narrow breast. The real answer to your question though is yes, an implant that is too wide for your measurements will stretch and thin your breast tissue and skin making you at a higher risk for rippling and implant palpability. You should see only board-certified plastic surgeons as you decide who will take care of you.Dr. Edwards

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

You should choose an implant that fits properly on your chest. This will avoid implants from pushing out off of your chest which can cause difficulties with exercise such as running as well as avoiding the implants comming together in the middle, called symmastia. Why would you want to deal with these issues. You need to be smart about your implant size.

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