Why Don't Doctors Encourage Women to Go Bigger?

For most patients, 500cc implants are big. In fact, for the average sized patient, if considering the biomechanical stress of an implant, a “large” implant probably begins at 350cc - 400cc. But implant size does (need to) vary based upon body habitus. A 260cc implant may give a petite woman a D-cup, but be insignificant for someone who is a muscular 5’10” tall.
There is significant morbidity associated with large implants: excessive skin stretching, the occurrence of stretch marks, aggravated implant descent below the level of the inframammary crease, thinning of the skin, wrinkling and rippling, breast ptosis, pseudoptosis, breast gland atrophy, etc. Some of these may occur soon after surgery, while others may occur in a more delayed fashion or over several years. Either way, these are sources of patient dissatisfaction, and the surgical correction is not always easy.

I do involve the patient in their implant sizing, but I prefer to follow a biodimensional philosophy for implant selection. I utilize measurements and other assessments of the breast-skin envelope to estimate the appropriate sized implant. This means that the diameter of the implant does not generally exceed the base width of the breast, that small tight skin envelopes require smaller implant volumes, and that more lax skin envelopes can accommodate larger volume implants. But in light of the potential morbidities listed above, just because there may be significant breast deflation and laxity does not mean that a large implant must be used to fill the breast back up; and so I am not afraid to also use a lift in those situations.

A successful operation, and a happy patient, is the result of good communication. I have detailed conversations with my patients regarding sizing, their desires, and the reasons why I believe biodimensional planning is important. I have patients perform sizing at home and/or in the office, and I also use intra-operative sizing to help make decisions.

My approach is individualized to each patient. I believe this approach minimizes stress to the breast, minimizes morbidity and associated re-operations, and yields better long term results. Utilizing this philosophy, I have re-operated on only two patients in the last twelve years to place larger implants; these re-operations were more than two years after the initial augmentation.

I know I don’t make the biggest breasts around…and I’m okay with that...and I know my patients are as well.

Best wishes, Ken Dembny

Your anatomy is the absolute limiting factor of what can be achieved, not your wishes (or even a surgeon's preferences or biases). The latter is evidenced by the differences in opinion in the answers, and your wishes should be foremost, though of course are subject to the limitations of your anatomy. However, since anatomical limitations are defined differently by each surgeon, this is what makes differences in opinion. This is one of those issues that is not black and white, but many shades of gray!

Experience with thousands of women requesting breast augmentation over several decades has shown me that all the crepe-hanging and naysaying about "big implants" are (mostly) justifications for a particular surgeon's point of view: "Large implants thin the tissue" or "Larger implants will require more surgery down the road" or "Large implants have more (rippling, heaviness, complications, drooping, etc. etc.). "Therefore, you must do what I say rather than what you want."

While there may well be a grain of truth in all of these statements, it would be like having your plastic surgeon concentrate his discussion for elective surgery on: "There could be infection" or "You could have a heart attack" or "You could die." All true, but come on! Do you really need to have this be the main focus of discussion?

The reality here is that your height and breast anatomy must go hand-in-hand with your goals AND your surgeon's skills in order to best achieve your desired result. If you have ascertained that you might want to go somewhat larger than a certain recommendation, and if you can communicate this to your surgeon, trust that s/he truly understands and accepts your request, and then trust that s/he will do the utmost to accommodate your request within the constraints of your anatomy (and will use the largest and best-match profile for your anatomy and goals), then it is certainly OK to choose large(r) implants.

And well within your rights to request this of your chosen surgeon, or find another experienced ABPS-certified plastic surgeon who will follow this plan. For examples of my breast augmentation patients who have implants of 550cc or larger, click on the web reference link below and look at cases 12, 24, and 31 (and compare these implant sizes to the other patients and their implant sizes). You will find that "average of 350cc" just has no meaning when you are individualizing surgery for each patient's goals and anatomy. Best wishes! Dr. Tholen


 

Having a  breast augmentation is a big decision for the patient. Many patients come with asking for a specific size of impalnts as regards volume. But when choosing implants you cannot just rely on a particular size. It is important to take many variables  into account including chest dimensions, quality of the skin envelope, height and weight as well as patient's occupation and recreational sports. Your plastic surgeon has to guide you in trying to achieve the best result for you with all those parameters taken into account and at the same time try to minimize complications. Finally you want to achieve a result that is also natural despite being large. Before and after photos help a lot in getting the surgeon and the patient focus in on the size peferred by the patient Like everyone else I, occaionally, have to change implants for a larger size. But the vast majority of patients are very happy with their result, in particular regarding size. Make sure that your surgeon spends adequate time with you so you are very comfortable with the choice of the implant. Good luck!