My doc suggests 425cc silicone high profile, but I want 475cc with moderate plus profile.

5'8", 135 lbs. I've lost 112 lbs. I'm having a breast lift w/ aug. under muscle. I would like to go bigger to a size 475cc. under the muscle w/ moderate plus profile but he is telling me I can't go larger because I could loose blood loss to the nipple and cause a dead nipple. I am also getting a tummy tuck as well. I've called around and asked other plastic surgeons If am limited to size with this type of procedure and they say they have never heard this before. Can someone PLEASE HELP ME!!!

Doctor Answers 12


 475 cc should be OK . Usually the skin is more forgiving after weight loss. I hope you don't smoke though. Still amazing to think that 15cc of fluid fits in one tablespoon.

Fayetteville Plastic Surgeon
4.7 out of 5 stars 13 reviews

Implant Size for Breast Augmentation with Breast Lift

When patients undergo breast augmentation in combination with breast lift surgery, safety should be everyone's first priority. Although this combination procedure is considered to be relatively safe, complications do occasionally occur.

One of the more significant complications following this type of procedure is necrosis of the nipple areola complex. This occurs when blood supply to the areola is compromised. This can occur for a variety of reasons including the surgical dissection, a tight skin closure and large breast implants. Each of these factors has the potential to disrupt blood flow by dividing blood vessels or compressing them. There's no question that the potential for this type of problem increases as implant size increases.

It's important to realize that no two patients are ever exactly alike and for this reason, treatment needs to be individualized. Each patient has a unique starting point, anatomic findings and aesthetic goals. Under these circumstances, it's impossible to make a recommendation without performing a physical examination.

At this point in time, your surgeon is the only individual who's performed a physical examination. It's important to realize that a physical exam might make the rest of us see the world the same way. For this reason, it might be reasonable to seek a second opinion from someone who can actually perform a physical examination as well.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

My doc suggests 425cc silicone high profile, but I want 475cc with moderate plus profile.

Breast augmentation with a lift may be a reasonable option, but an exam will be necessary to make a determination. Find an expert in breast surgery in your area who has great reviews and great before and after photos.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Surgeon wants to use one size; patient wants another!

Since the difference between these two implants is just over 3 tablespoons, that cannot be significant enough to cause ischemia. Yet, there IS indeed a point before which everything is OK, and just beyond which problems occur. No one, including your surgeon, knows EXACTLY where that point is, so going with the more conservative volume but higher profile may be his "maximum compromise."

However, slightly wider and 50cc larger does not seem to me to be a "make or break" issue. If it appears you and your surgeon are at loggerheads, it is indeed time for consultation with one or more ABPS-certified plastic surgeons (ASAPS members) with lots of breast surgery experience, and a few additional opinions.

By the way, congratulations on your weight loss! One thing I've found in operating on lots of massive weight loss patients is that their cutaneous blood supply is "better" than women whose breasts were not formerly larger. I think this gives you a bit of a safety margin, but it is a judgement call that your chosen surgeon will have to make. Anatomy does have certain limitations. Best wishes! Dr.Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews


There are several factors that plastic surgeons consider when recommending implant sizes. I consider two factors when selecting implants for my patients:

1. Dimensional planning
2. Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look. Hope this helps.

Dr. Basu
Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Trust your plastic surgeons judgement

It is very unlikely that either of the two implants would cause enough pressure on your soft tissue to cause nipple blood supply impairment.  This, however is a judgement decision that can only be made by your plastic surgery.  He sounds like he is concerned about a successful out come and your safety.  If you trust him to perform your surgery then you should trust his judgement.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Implant causing nipple death

I am sure you plastic surgeon has a reason why he/she would not to place a large implant based on your evaluation. You should ask your plastic surgeon directly the reasons why they will not place a larger implant with the profile that you like.

Decision has to be made during the surgical procedure

Usually the patient and I discuss options on size and shape in our pre-surgical visit and there are no absolutes. I have a variety of styles and shapes available during the procedure because the size may need to be increased or decreased as necessary. If you are not sure about the decision of the Plastic Surgeon, please get a second opinion. It can't hurt.

Itzhak Nir, MD, FACS
West Palm Beach Plastic Surgeon
4.9 out of 5 stars 38 reviews

My doc suggests 425cc silicone high profile, but I want 475cc with moderate plus profile.

Sounds very unusual to me! Maybe your decision on PS needs to be revisited. The volume difference from 425 to 475 is ONLY 50 cc's a few ounces. I do not really understand the refusal by your chosen PS. Are you sure he/she is a board certified Plastic Surgeon? Go to ASPS web site... 

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

My doc suggests 425cc silicone high profile, but I want 475cc with moderate plus profile.

Based on your question and your physical dimensions, you are probably a very petite person.  Your surgeon is likely concerned with the base width of the implant.  If the implant is too wide for your chest wall, you will be able to feel the implant in your armpit, which is very undesirable. I would talk with your surgeon about your desired volume.  Your surgeon may be able to find an implant that fits your desired volume and your physical characteristics.  I recommend being very comfortable with the surgical plan before proceeding.  If you feel like you are getting something that you don't want then be open and honest with your surgeon until you are both on the same page.  Best of luck.  

Jason Mussman, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 3 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.