Sizing concern. Does anyone have experience with this issue?

Question

I feel like my breasts look like two small tennis balls glued to my chest. Due to capsular contracture I I’ll be exchanging to silicone. My dr wants to go up to 450 cc to make me more “full” and I’m scared this will look like a pornstar on my small frame. I trust my surgeon but does anyone have experience with this issue?

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well;..based in your question its difficulted evaluate your case if the question dont have a picture, its recommended to get a consultation in personal with a plastic surgeon.

Daniel Barrett, MD · Answer

Hi Jasmino,
Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient.  
  
The two main types of implants are silicone and saline. The shell of the implants can be either textured (which reduces capsular contracture) or smooth. A textured implant sometimes requires a larger incision. The shape of the implant can be either round or tear drop shaped (gummy bear). Both have their advantages and disadvantages.
  
The different types of implant offer different pros and cons. For instance, the pros of silicone implants are that they look and feel more natural and ripple less.
  
On the other hand, the pros of saline implants are that they do not require as large of an incision as silicone, less expensive, they have less incidence of capsular contracture (scarring around the implant), one can tell immediately if there is a rupture, the size can be slightly adjusted, and they can be used for women less than 22 years of age.
  
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements. 
  
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match. 
  
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
  
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals. 
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The best treatment for capsular contracture is total capsulectomy and implant exchange.  In regards to increasing your size from 325cc to 450cc, this will depend on your individual breast anatomy.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Kenneth Hughes, MD · Answer

Hopefully, you have tried on sizers or viewed images of how your breasts will look when the size is increased by 125cc's.  The average implant placed in the US is 350cc.   I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy.  Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision. Based upon his/her credentials, trust your surgeon to make the best decision in the OR.

Richard Baxter, MD · Answer

It sounds like those are very large implants for your frame. Your new silicone implants should have a more natural shape and profile than saline especially if you have capsular contracture. They do not necessarily need to be larger, so be sure you get what you want.

Adolfo Sesto, MD · Answer

Hi. You do need to undergo a capsulectomy and change the saline implants for Silicone Cohesive Gel ones placed under your muscles to avoid migration and get a natural look.  In my experience 450 CC's is a good volume for you. Talk to your surgeon about your concern and good luck.
International Member of the American Society of Plastic and Reconstructive Surgeons (ASPS)
Member of the International Society of Aesthetic Plastic Surgery (ISAPS)
25 years experience

William B. Rosenblatt, MD · Answer

Bigger is not always better. Perhaps a second opinion would help -- Also imaging with Crisalix might help you see what you will look like with significantly larger implants.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. It is not unusual to received different opinions from different plastic surgeons.  Ultimately you will need to do your due diligence and feel comfortable that the plastic surgeon you choose has significant/demonstrable experience helping patients with this type of complicated revisionary breast surgery.
 
In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants (I am not convinced that there is a difference with smooth versus textured implants as long as the breast implants are in the sub muscular position), and the use of acellular dermal matrix (especially for recurrent encapsulation). Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source (his human, porcine, or bovine in origin).Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural or pornstar look” or "C or D cup” or "full" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery ( after the use of temporary intraoperative sizers). Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select the best breast implant size/profile for the specific patient.
I hope this helps. Best wishes.

John E. Nees, MD - Account Suspended · Answer

Hi and welcome to our forum!
Your implants look like "tennis balls" due to the capsular contracture, where the breast becomes firm, becomes spherical in shape, and may become uncomfortable or even painful. Depending upon the thickness of the capsule, capsulotomy or capsulectomy will be required. Replacement with a different type of implant in a different plane is usually recommended. 
An increase of 125 cc will increase ~~ a cup size. Some studies have demonstrated an increase in capsular contracture rate with the use of  larger implants. 
Consider your options. Discuss pros and cons with your surgeon and make an informed decision.
Best wishes...

Jon Ver Halen, MD, FACS (license suspended) · Answer

Dear Jasmino,Hello and thank you for your excellent question. Based on your description, I think that your surgical plan sounds reasonable.  They implants may look larger, but I think that it will improve the "tennis ball" appearance you are complaining about. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!
  
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon
  
Texas “Top Doc” 2017, 2018
  
RealSelf100
  
America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018
  
BeautyAdvisor Top Contributor

Sizing concern. Does anyone have experience with this issue?

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