How big is too big for breast lift with implant? (Photo)

Although you may have fixated on 700-800 cc implants I doubt that you have a realistic idea of what you will look like afterwards. Here is why: It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in a bit.

A lift with an implant is controversial
for two reasons. First, when you perform a lift you are making everything
tight and closing the wounds under tension. It you add the expansive
forces of the implant at the same time, you are fighting against yourself.
There are forces on the wound which try to make them separate, which
results in wider, thicker, more irregular scars. In the worst case, the
wounds will open. So compromises are usually made in the operating room
by the surgeon because they cannot close the lift wounds over the appropriate
sized implant. Either less of a lift is performed so that the skin is not
as tight and therefore there is less tension on the closure. Or a smaller
implant than would be appropriate is used so as to decrease the expansive
forces. Either way, you are compromising the aesthetic outcome.
Often the outcome is so compromised that a second revision surgery is
required. If however, you plan to have the lift first and then the
augmentation after everything has healed, then you have two operation that are
planned, both with much lower risk than the combined mastopexy/augmenation.
The outcomes of the two meticulously planned operations are much better
and a more aesthetically pleasing, and a safer outcome is achieved.



The second reason the combination of
mastopexy and augmentation is controversial is because of the risk of nipple
necrosis (death of the nipple). By making the skin tight for the lift,
you are putting external pressure on the veins that supply the nipple. By
putting an expansive force on the undersurface of the breast with an implant,
you are putting pressure on the thin walled veins that supply the nipple.
If the pressure by squeezing the veins between the implant and the skin
is greater than the venous pressure in the veins, the flow will stop. If
the venous outflow stops, the arterial inflow is stopped. If the arterial
inflow is stopped, there is no oxygen for the healing wounds and the tissue
dies.



Placing
the implant on top of the muscle in combination with a lift puts the blood
supply to the nipple at a much higher risk because in addition to the issue of
pressure on the veins, you have to divide the blood vessels that are traveling
from the pectoralis muscle directly into the breast (and to the nipple) in
order to place the implant between the breast tissue and the muscle. This adds
a third element of risk to an already risky operation.
Mastopexy/augmenation with sub glandular implant placement is by far the
riskiest way to address your anatomic question.