Making Space for Implants Larger Than Implant Size a Standard Technique?

I am 38, 5'1", 96lbs. with approx. 30A bra size. The physician I am considering (CV a mile long and who is VERY well recognized) likes to make the cavity for the breast implant larger than the implant itself to allow for more natural movement. Is this common practice? Concerns with this technique? He plans on going with saline submuscular. He said 250-300cc, filling to about 275cc, which seems a bit on the small side to me to get to a mid-C cup. I was thinking more 300-325cc, but does my narrow frame limit the size?

Doctor Answers 15

Implant choices

Choosing the right implant for you is a lengthy discussion and exam performed by your surgeon. An agreement and rough size range should be discussed with your surgeon. If you want to go bigger discuss it with him.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Making Space for Implants Larger Than Implant Size a Standard Technique?

While I make the implant larger enough to accomodate the implant, i am reluctant to make the pocket any larger especially laterally to avoid the implants falling to the outside.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Don't micromanage your surgery...

Hi there-

It is not in your best interests to get too involved in the details of your surgeon's preferred technique... Find a surgeon you like and feel you can trust, and then get out of his or her way and let them "do their thing".... Your chances of achieving an outstanding outcome will be much higher.

Conversely, I can tell you that the MOST unhappy patients I meet are those who come to me for correction of funny looking breasts after they had another surgeon twisted into knots because they (the patient) made them do things in a way they (the surgeon) would not have done had they had the professional freedom necessary to achieve the best outcome.

For more on this topic, please read this:

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

You might have to reduce your cup size aspirations to achieve a natural result

Absolutely, the cavity for the implant must be made somewhat larger then the base diameter of the implant itself. An implant that fits tightly within this cavity would have the same effect as a scar tissue contracture around the implant.  Like this complication of contracture, the tightly fitting implant will feel to firm because it has no room to expand when pressure is applied to the breast.  While a undersized cavity is problem one made to large can also be problematic. If the cavity is excessively spacious the implant can drift into unwanted areas such as under the armpit. In other words, the dimensions of the implant space  must be made just right .

I would agree with you that the recommended implant sizes will fail to make you a mid C cup. However, I would also say that based on your dimensions achieving a natural looking mid C cup is an unrealistic goal. The size implant necessary to accomplish this must be significantly larger then recommended and it will not fit comfortably in your body without that exaggerated "implant look".  Sight unseen, I think your surgeons implant recommendations will be most appropriate for your anatomy.

David A. Ross, MD (retired)
Chicago Plastic Surgeon
4.6 out of 5 stars 89 reviews

Pocket Size for Breast Implants

First let me comment on the implant size.  He's right!  For a woman of your size and small frame the implants and fill volume will put you at a "full C."  Next, I don't agree with making the pocket bigger than is necessary.  You don't want the implants moving around in the pocket.  This can allow them to fall to the sides when laying down; although when standing they might be fine.  The tissues stretch with time and a natural look will be achieved regardless.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 33 reviews

It is alway about size

It sound like everything you have described is very reasonable. Concerning the size you must sit down and have a very frank discussion with your plastic surgeon about your size! Voice your desires and listen to his reasoning for his implant choice. At some point in your decision making process you will have to decide if you trust his experience and opinion. If you do then move forward.

Good luck

Dr. ES

Choice of a plastic surgeon

I completely agree with Dr. Aldea. You need to be confident in yor choice of surgeon and ultimately let them do what they do best. You wouldn't try to tell a pilot how to fly the jet or a top chef how to cook your meal...

With respect to the pocket it does need to start out slightly larger than the implant for the most natural look and feel. From your body though, you would be advised by most to have gel implants because you will be pretty aware of wrinkles and ripples with saline.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast implants should fit the pocket hand-in-glove

We believe in breast augmentation with a saline or a silicone gel implant, the best results are seen when there is a marriage between the implant and the breast, such that they move and feel as one. The pocket and the implant should fit one another comfortably. If the pocket is larger, the implant will tend to slip up on the chest, or as you lie back, can appear to slide to the side of the chest. We prefer a perfect fit, hand-in-glove. Others may have the idea that if the pocket is larger, the risk of capsule contracture may be smaller, but we don't believe this to be true and this is not a 'standard' practice.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Picking a Cosmetic Plastic Surgeon...

After meeting several well chosen Plastic surgeons in consultation, most people narrow the list and pick their surgeon based on the most subjective of criteria and the feeling of comfort the surgeon gives them. After all, if they are all equally professional and well trained, have happy patients who sing their praises, nice offices and staffs, there is not much else to help you make the cut.

At this point, you are in the same situation as you face whenever you make a great decision (such as marriage, career etc). You go with your feeling. And even then The Forrest Gump adage of Life being like a box of chocolates applies. No one REALLY knows what they will get - but we hope it would be THE right choice.

It seems to me that if you chose your surgeon with care, you should leave the doubts and micromanagement aside. He/she knows what they are doing and unless you take a few years to train in Plastic Surgery, hard as you may try and if you were extremely intelligent, you would really not have the experience of a well trained Plastic surgeon.

This was my zen advice to you. Let it happen. If you chose well - it's the best you can do.

As regards breast implants pockets. They need to be made just slightly larger than the implant to avoid that all-too-common encased melon or zit about to pop look seen when the skin appears to be painted on the implant (also seen with capsular contractures). Ideally, to avoid seeing and feeling the implant shell folds and ripples, the implant SHOULD be covered by the existing breast tissue and muscle. If you do not have enough to cover your desired implant you probably should consider having Silicone gel filled implants which ripple less than saline implants. With a 30A and a petite light frame, I would strongly advise you to consider it. This may make larger implants less noticeable / palpable.

Good Luck.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Breast Augmentation Chicago

I generally do not make the pocket any bigger than than the implants itself.  Making the pocket larger than the implant is an older way of doing the surgery.  Now, we want to have things sit in the pocket just right, especially if you are so small.  Overtime, the implants are going to stretch out the pocket to a degree, so I would not be worried about them moving naturally at all. 

If you are trying to get to a mid-C, then 275cc will not get you there.  You probably do need something in the 325cc to get a nice C.  Depending on your chest size, you probably need a moderate plus implant or a HP implant.  These are things I would discuss with your surgeon before proceeding with surgery.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 73 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.