What Are Realistic Long Term Results with 650 Cc Silicone Implants? (photo)

I'm 29 & mother of 4. I had a tummy tuck & breast lift 4 years ago & love the results but miss the volume I had pre-pregnancy. We opted not to do implants bc my husband was unsure but now he regrets not adding the implants. My measurements are 36 32 38, 5'10", 168 lbs, B cup. Dr. has suggested 650 cc silicone implant placed under the muscle but I worry about sagging. I want to be as big as I can while looking natural & proportionate & keeping long term results in mind. Is the size reasonable?

Doctor Answers 18

Too Large Implants?

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Lots of stuff here to tell you. First, waiting was excellent if you were not sure. You burn no bridges by waiting except now you need another anesthesia which if you are healthy is no big deal at all. It used to be the absolute standard of care to perform these in two procedures. We now have such great techniques and have learned so much about augmentation and mastopexy that it has become a more reliable surgery to do together. Being that said, I am going to post you a very long answer here on how I think patients should think about sizing. It is very simple for me. Do NOT get caught up on a number. Pick the implant that fits YOUR body. Gravity wins, and yes you can bottom out over time. No way around that. So, here is a little bit on how to size breast implants for the breast.


In my opinion these situations that we find ourselves in with patients can be simplified. Sizing is not about a number. In fact, I do not even discuss numbers with my patients. If a patient walks through the door and says they want x-cc implants I have to educate them about how sizing works. The best analogy I can relate this to is buying shoes. When you go to buy shoes how do you do that? First you start with the size your foot is right? So if your foot is a 6.5 you try on all kinds of 6.5 size shoes. Some may be tall, some might be flat, and some might be somewhere in between. You would never try to buy a size 8 shoe because it would be too big for your foot right? Breast sizing is the exact same way. Implants come in several different profiles that are like different heights of shoes. Implants can be low profile, moderate profile, or high profile. There are even implants that are higher than high. That would be your high platform shoe. Each implant style give you a different look. Now, your breast has a defined width that we call the base diameter of the breast. This would be analogous to the show size. Your breast base diameter never changes. It is what it is. So now, you can choose several different style of implants that fit the number of your breast base diameter. That really narrows down what implant is best for you. So once you know your breast base diameter you can try the low, moderate, high or really high implants on. The only think you have to decide is which look you are going for. You would never put an implant that is 13 centimeters wide in a patient whose base diameter is 10 centimeters. Half the implant would be in the armpit. So, this is very simple to me. My patients get a few choices that fit their breast and that is it. I will not put an implant in a patient that is too wide for their body because it will harm them over time. Hope this helps.

Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Choosing implant size

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In my experience the best way to choose an implant size is to try different size implants in your bra and then put a form fitting shirt on over. You should be able to do this at your surgeon's office. If you want to try at home, you can place 650cc (use a measuring cup with cc's marked on it) of uncooked rice or jello in a baggie and put it in your bra and then try on different clothes. No method is an exact predictor of post-operative size, but it can give you an idea. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

650cc implants seem like a reasonable plan to fill loose skin.

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As others have stated, without personal examination it is impossible to give meaningful advice regarding the appropriateness of your choice. Trying on implants in a bra and stretchy top will help you determine if 650cc is in keeping with your goals, and only your surgeon can evaluate your exact anatomy at the time of surgery to determine if your choice is compatible with your tissue/skin laxity requirements.

That being said, there tends to be a bias against large implants in many of my colleagues' answers, when in fact I find at surgery that precisely those large(r) sizes tend to be required to adequately "fill" a woman's loose breast skin! Small(er) may be better when there is no cutaneous laxity, but when trying to avoid the scars and cost of a breast lift to tighten loose skin (or in your case, having to re-do your lift), adequate implant volume is often required to fill the existing skin brassiere and avoid the "rock in the sock" appearance!

So, if YOU like the look that 650cc provides, and your tissues require the volume that 650cc provides to fill out your deflated breasts, then by all means do not be deterred by talk about "sagging sooner." Genetics and individual skin elasticity are much more important determinants of "early or late sagging" than 8-10 ounces of implant volume. And, of course, you can always re-lift your breasts or reduce implant size (or both) later in your life if you so choose. Do what works best for you now; the future is promised to nobody! Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

What Are Realistic Long Term Results with 650 Cc Silicone Implants?

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Over the internet even with posted photos very hard to advise. 650 cc might be too large. But 600 cc UHP implant would be better. 

Large Breast Implants OK for Me? (photos)

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Yes, 650cc is reasonable, provided base width of the implant matches your breast base width, and (in my opinion) you're not an avid runner, volleyball, or basketball player, in which case very large breasts may be cumbersome and uncomfortable.  May not look "natural", but what is natural anyway?  My guess (emphasis GUESS) based on experience is that you'll be proportionate and sexy, but large busted.  Again, as discussed on our website, dimensions of the implant (width and projection) are much more germane in determining whether they are right for you than volume.  A 650cc implant that is wider than your base width is too large for you, and a 650cc implant narrower than your base width may be too diminutive.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Large Implants will fit

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650 cc implants placed under the muscle will work just fine for you.  Once the pockets are created and the implants are in place, a capsule will form around the implant and help it to stay in the proper location.  Sagging occurs more often when the surgeon makes the pocket too large or there is too much excess breast tissue in the lower part of the breast.  Your chance of future sagging is low especially since you already had a lift and you have settled normally.  You might inquire if your surgeon can redo the vertical scar when he/she places the implants.  If the decision to not use implants was made by the surgeon, there should be a discounted price for placing them now.  If it was your decision against the surgeon's recommendation, then you should pay for a regular augmentation.

Martin O`Toole, MD, FACS
Los Angeles Plastic Surgeon

Implant Selection Process

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Despite your previous breast lift, you will be prone to further sagging with large implants.  In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.
Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Are implants too large?

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Thank you for your question and for providing the photos. Selection of implant size leads to much of the anxiety of breast surgery, and thinking about the long term results instead of volume is a wise thought. The axiom that larger implants sag more over time is true. It also makes intuitive sense when you remember that larger implants weigh more and will therefore, over time, stretch the skin more. This needs to be taken into account when selecting the implants.

To get a full but natural result, select an implant whose width matches the width of your chest. The choice of projection will then determine how full you will look. I can't make an determination without examining you, but a 650cc implant does have a fair amount of weight and will likely sag over time.

It would be best to talk about your concerns with your plastic surgeon. Make them aware of your concerns over the long-term result and try to balance your desire to look full with the risk of recurrent sag. I am sure that a happy medium can be reached.

Best of luck with your breasts.

Jeff Rockmore


Risks of large implants over time

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It is great that you are thinking about the long term because all too often patients focus on immediate results.  Over the long term, 650cc implants will certainly lead to more sagging of the breast than a smaller implant.  Given that you needed a breast lift your tissues have already shown that they are somewhat loose and this will increase the stretching of the tissue over time.  With an implant that large you will also need adequate support to keep them from sagging as well.  That likely means bras nearly 24/7.  Don't forget that you can still use clothing to accentuate your look even after a breast augmentation.  You don't necessarily have to have a full look every waking moment of your life and you can use clothing for an extra umph when you want to.  With a more modest augmentation you can minimize the risks of long term droopiness and still improve your shape.  Make sure you review the long term results with your surgeon before your procedure.  Good luck.

Jason E. Leedy, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 147 reviews

650 cc implants

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650 cc implants are very large and they may lead to early laxity.  Without an exam in person it is difficult to assess what would be best for you.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.