What does my Dr. mean when he says I didn't have enough tissue for larger implants? (Photo)

I'm 5'11'' 140lb., and was a 36a...even smaller if that's possible! I wanted a D cup, he mentioned that 425cc was the most he wanted to go for my frame etc. I had my post op today, and he told me that he didn't feel he could have gone any bigger because I didn't have enough tissue. He said it might be possible in 6 months to a year to revisit the size after I let the tissue heal. But what does that mean? How will I have more tissue to work with in a year?

Doctor Answers 10

Large augmentation in a small frame

There is only some much implant that can be placed in a small breast at one time.  In one year the breast will be stretched out more and a new larger implant can be placed.  It should be noted that putting too large of an implant in a small breasts leads to problems later.  You might consider getting several opinions before you opt to go even larger.

Austin Plastic Surgeon
4.9 out of 5 stars 57 reviews

Avoid over implantation

At size 36 A each 200 cc’s of implant corresponds to 1 cup size change. To achieve a D would require 600 cc implants. Since you have had 425 cc implants and your skin envelope is tight, it is unlikely that he could put in 600 cc implants. The elasticity or stretch of your chest would not accommodate implants that large. If a large implant was attempted, they would extrude inferiorly and laterally requiring revision. Over the next 6 months to a year, your tissue will stretch out and be able to accommodate that size implant. However, implants that size are heavy (weigh more than 1 lb each) and they will descend. I always recommend small round textured silicone gel implants placed retro-pectoral since they look and feel more natural, are more stable, less likely to ripple or have complications needing revision. Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it. I would NOT recommend larger implants because you will likely have complications and require revision.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

What does my Dr. mean when he says I didn't have enough tissue for larger implants?

Just as in pregnancy your abdomen stretches so does the breast with an implant in place. In some cases we use a breast expander to stretch the tissues before implanting a permanent implant... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Larger Breast Implants

Thank you for your picture.  Your surgeon is probably referring to the amount of stretch (lack of give) that you skin has to accommodate  larger implants.  3-6 months from now your skin will relax and could be stretched a bit further to accommodate larger implants



Thank you for the question.

I agree with the picture that shows your actual breast size, they're not stretchy enough to fit a larger implant and I do agree with you PS to wait for the skin laxity.

Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 252 reviews

What does my Dr. mean when he says I didn't have enough tissue for larger implants?

Your post operative photos show that your skin if very tight.  Your surgeon likely placed the largest size implant that he could without disrupting the infra-mammary fold.  That would have caused various problems including bottoming out of the implants and/or double bubble.  Once implants are placed, the skin and muscle will stretch and relax allowing a larger implant to be placed several months down the line.  I hope this helps!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 106 reviews

What does my Dr. mean when he says I didn't have enough tissue for larger implants?

I think he probably meant your tissues overlying the implants were too tight as the photo appears that way. If you still want to go bigger, allow the tissues to soften for several months and your body will accept a larger implant with no problem.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Bigger Implant

You appear to have a tight skin envelope and I agree that not much larger an implant could have been placed at the time. Over the next 3-6 months the pocket will strtch out and a larger implant can be used.

John Squires, MD
Denver Plastic Surgeon
4.9 out of 5 stars 79 reviews

What does my Dr. mean when he says I didn't have enough tissue for larger implants?

Every patient's anatomy will dictate how large of an breast implant can be used SAFELY.  If a surgeon tries to use a breast implant that is too large for a patient's frame, the patient will be exposed to risks such as breast implant displacement/malposition (such as symmastia, lateral breast implant displacement, bottoming out…) or greater palpability/rippling of the breast implants.
In your case, as your tissues  “relax” over the course of the next several months, it may be possible to increase breast size further. For now, continued patience and continued follow-up with your plastic surgeon will be in your best interest.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Tight envelope

Hello, your doctor is right, you have a tight skin envelope, which means there is not much room to fit in a big implant, but skin has the ability to expand after a couple of weeks when the implant settles in and the skin doesn't feel that tight, so after 6 months a bigger implant may fit in. Remember a bigger implant may look better, but it also means more probability to trouble right after surgery or on the long run. At this point, I would tell you to use a lot of moisturizer cream so you don't get stretch marks, and I mean a lot, in 6 months if you still want bigger implants, talk to your Plastic Surgeon, right now you have a beautiful result, just let it settle, you may be surprise as to how happy you are with your new size. Good luck!

Jose Leon, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 71 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.