Problems can develop with saline implant overfill
A saline breast implant is designed to have an acceptable fill range or volume. For a 425cc saline breast implant it may be possible to fill the implant to 475cc and stay within the fill range without loss of performance. If the implant is 'overfilled' the silicone rubber envelope will be under increased stress and the life of the implant may be shortened.
Also, the implant will round up and stiffen and lose the soft feel and natural shape. The edges will 'scallop' or form small waves of folds which may be apparent if the breast coverage is thin. The best results will occur when the appropriate implant is selected by the surgeon, and used according to how the implant was designed.
Saline implants are a wonderful product and work very well when matched to the right patient. You can have a smaller concealed scar, avoid leak worries, reduce breast capsules. When breast cover becomes thin, or the implant required becomes large, perhaps 450cc and over, a silicone gel implant may be a better choice.
Spend plenty of time considering choices and trade-offs before settling, and don't expect the implant you tuck in your bra to look and feel like your actual augmentation result. It would be nice, but implant selection is not that easy. Never underestimate skill and judgment.
Best of luck,
Which breast implant would be best for me? Chapter 2
One of the things I find most interesting is the confusion many women generate within themselves when researching breast augmentation surgery. In particular, I think that many patients become overwhelmed with implant choices and the abundance of information about these options available on the Web, and they start to want to micro-manage the surgery. This is a dangerous road that usually does not lead to patient satisfaction....
This is complicated once they contact a surgeon or two for information about the implants, and which is most likely to give them the result they desire. Somewhere along the way, opinions expressed by a surgeon are perceived as fact by a prospective patient (because of the surgeon's reputation or the apparent strength of his/her opinion), who then becomes more confused when she hears a differing opinion.
This leads to ridiculously technical questions being posted on sites like RealSelf and others, such as:
"I am 5'5", 125 lbs, my measurements are 34, 22, 36. I have had 3 babies, all by C-section, and I breast fed two of them. My breasts sag a little, but not as much as some women I have seen. I want to have a full C-cup breast. Should I get 325 cc Allergan 410 style implants, or Mentor 350 cc Moderate profile implants. Projection is more important to me than a natural shape..."
Every time I get one of these over-thought questions, I always think the same thing... ???????
Let's take a big step back from the trees here and take a look at the forrest in front of us, shall we?
Fundamentally, the reason any woman seeks breast augmentation is because she wants to achieve a certain appearance, right? Let's repeat that- to achieve a certain appearance. NOT a certain bra size, or a certain implant volume, or even a certain implant type. When you first stared to think you might want an augmentation, you didn't think, "I would like it if I could have 350cc implants"... You probably thought, "I would love to look like that (after admiring another woman's breasts)..."
So if we can agree that what you are really after is an appearance you would be happier with (as I always tell my patients), let's make the desired appearance the focus of our communications...Let us both ignore bra sizes (which are not standardized and the choice of which is very arbitrary) and implant types/sizes (for now)... Let's first understand what you want to look like. I think you would agree that if we are able to make you look the way you wanted to look, the letter on your bra and the number on your implant is lees important, right? Help me understand what you want to look like, and I can give you a very accurate recommendation of options for achieving that appearance -- provided a careful physical examination has also occurred.
Why is the exam so critical? After all, can't we just put small implants in women who want small breasts and larger implants into those who want larger ones?
The exam is critical, because for any one particular woman, there are only a few good choices of implants available, regardless of her goals, and these options are arrived at by taking careful stock of her breast tissue, skin, and frame. In other words, your anatomy will, to a large extent, help us understand the implant options that would make you look the best. This is the "One Right Result" concept. The taking of these measurements is so important, I do it myself every time, and based on these measurements and my patient's goals, then make recommendations regarding the implant options available to her (as these options would be different for different women).
While (as with any aesthetic procedure) no guarantee of outcome can be given, you are much more likely to achieve your desired outcome if you focus on communicating your desired appearance successfully with a skilled and experienced, Board Certified Plastic Surgeon than by over-researching the implants and micro-managing the details of the surgery. In fact, I can think of no better way for you to increase the odds of you ending up dissatisfied.
So don't over-think it. Think carefully about the appearance you want, communicate it carefully to your surgeon (using photos if possible), and make sure that the implant choice arrived at by the two of you together is based on both your anatomy and your goal. You'll be happier and the process will be less stressful!
It is hard to predict the exact cup size for you after getting implants. A 425 cc implant may get you in to a "D" cup.
Determining breast implant size.
There are many ways that plastic surgeons determine what size to put in. Some will have the patient place sizers in a bra they want to fill out. Some will make that determination on the table. Patients will also sometimes bring in photos of breasts that they like and see if it is a reasonable goal. Some patients are very specific as to how many cc's, profile, etc, (mostly because that is what their girlfriend got...) I tell patients to please don't fall in love with a particular cc. It all depends on them.
The most accurate that I have found is measurement of the base width. Using this measurement, the plastic surgeon can get an idea of what size the patient should be. I will usually bring in a size above and below into the O.R. with me. There is a dynamic interaction between the chest wall, soft tissue of the breast and the implants themselves. Judgment is often used at time of surgery. Sometimes "overfilling" of the implant is warranted, (they actually have a fill range). It all depends on the individual.
Make sure your board certified plastic surgeon knows your goals before you go to the O.R.
Implant sizing for breast augmentation
It is very difficult for a patient to pick a specific size, and for this reason I recommend that you speak with your surgeon directly about your concerns regarding sizing. It's hard to predict exactly what size you will be after surgery, as bra cup sizing differs so much from one manufacturer to the next. Regarding overfill of the implants, with either size I would recommend slight overfill to prevent rippling of the implants. With silicone implants, there's less chance of rippling and frankly a more natural feel to the breasts. I agree with staying under the muscle. Finally, keep in mind that your risk of complications goes up with smoking, including bleeding, infection, capsular contracture, and anesthesia risks. If you can quit for 2-3 weeks prior to and after surgery, your course will be much smoother. Good luck.
Better to "overfill" breast implants
You may get some different opinions on this on issue, but in doing over 1000 breast augmentations, I have come to the following opinions.
1. Saline implants do not feel as good as silicone but are still an acceptable option for most women. Be sure to know the pros and cons of each. Most women with saline are happy with their results.
2. There is a role for all profiles of implants (low, medium and high). The profile choice is best chosen by the surgeon that best fits your frame for the given size implant you choose.
3. Filling saline implants to the upper level of the fill range will increase the lifespan of the implant, not decrease it. Filling to the lower fill level leaves more fold ceases in the implant, which is where failure of the implant usually occurs.
Be informed and know your choices. Ask questions and be wary of anyone who tells you there is only one option or "right" way to do this. Good luck.
400 cc's are not "smaller implants"
You will probably be happier with gel as the salines will ripple laterally if you lean forward even under the muscle. Also, HP implants create a very specific "look" and you need to be sure you like that look because it certainly isn't "natural." I'd advise visiting at least 3 qualifed plastic surgeons and seeing what they recommend.
Confusion in Breast implant sizing for breast augmentation
My primary concern with any breast implant is your overall bodyweight and relatively thin soft tissue coverage. I tell patients to imagine a baseball covered with a silk sheet: you will see everything. Well looking at you, your bones are clearly visible.
Your natural tissues cannot even conceal your own bones so how can they conceal an implant, which is placed above the bone level?
- Placing your implant under the muscle is a beginning
- Staying with a reasonable sized implant is another
- Considering high profile to limit rippling may be beneficial
- Use of silicone implants may enhance the natural look and feel
If you like the 425 sizers on, then using a final fill of 465 to 485 will achieve relatively comparable results when placed under the muscle.
Smoking will not only effect the appearance of the scar but will make your recovery from general anesthesia more difficult.
Choosing the correct size of breast implant
There are generally 3 methods of choosing the correct size of breast implant for an individual.
1)The first method involves taking a number of standardized measurements of the breasts. These measurements are then transferred to the manufacturers charts and the "correct" size is then determined. This often gives a conservative recommendation with the largest size on the chart rarely above 350cc.
2) The second method involves trying on sizers. This gives the opportunity for the patient to see what she will look like after surgery. Most patients prefer this method as gives them what they want.
3) The last method involves 3D imaging software which gives the advantage of seeing what the breasts will look like with the chosen volume of implant. This is new technology and depends on the accuracy of the software.
The advantage of silicone is that in real thin individuals it will feel more natural and there will be less risk of rippling. If you choose saline, I would go with moderate plus implants 400 cc overfilled to 450cc. This will give the appearance of 425cc implants.
Fill volume for saline implants
First, for the size range you are considering I agree with Dr. Teitelbaum that silicone is a much better choice than saline. One thing that is helpful in thinking about saline implant fill volumes if you do decide to go that route is that 5cc = 1 teaspoon, so we are really talkning about very small increments in terms of 400 vs. 425. Saline implants have a nominal (minimum) fill, the stated size of the implant, and most surgeons will add more. that is because at the minimum fill the implants will be too ripply.
However, the higher the overfill, the firmer, rounder, and more unnatural they become. Regarding the smoking question, the reason why it is good to quit before (and after) surgery is that nicotine constricts blood vessels, leading to poor blood flow to the healing tissues. There are some procedures (facelift, breast lift, tummy tuck) where it is an absolute requirement to quit because the potential problems with healing are so significant.