Do Saline Implants Feel/look Better if Filled to Max or Overfilled?

Saline breast implants are sized according to the minimal fill volume. There is also a maximum recommended, usually about 10% more than the nominal fill, so when we say overfilling it is something above that. For example, a 330 cc implant has a recommended fill range of 330 to 360, above 360 is overfill. The trade-offs are that at lower fill volumes they will feel softer but more ripply, at higher fills they will have less rippling but be firm and unnaturally round. The optimum fill volume depends on balancing these factors, which is different for each patient.

Overfilling is a point of contention and taste among plastic surgeons. To me, it depends on the profile. While I may overfill moderate implants, I generally fill to the upper limits of moderate plus, and  fill less than max with high profile because this creates an overly round shape

You always want to overfill the saline implants to some degree.  If you do not, then there are usually a few bigger folds in the implant.  By overfilling them to some degree, you can help decrease the folding of the implant.  However, if you overfill them too much, you can get some very small, but numerous, rippling on the edges.  The goal is to find that balance between the two.

In general we recommend completely filling or slightly overfilling saline breast implants because we know from experience that if the implants are underfilled significantly, there is a higher chance of rupture (the edges of the implant fold and rub against each other and over time the wall of the implant weakens.  I don't think overfilling the implant will make it look or feel too much different, and if your priority is the best look and feel, the silicone implants are the best choice.

As a basic principle, I always encourage a patient to choose an implant which has a "footprint", which will fill their chest.  The choice of "profile" depends on how much superior pole (area between the collar bone and nipple) fullness they'd like to achieve as well as what their native breast tissue provides.  For example, a tight chested young individual may target a more projection (high profile) than a post pregnancy woman who wants to modestly fill up her skin brassiere (moderate plus).  Interestingly, the practice of overfilling saline implants can mitigate against palpable lateral edge wrinkling, however the overfill imparts a rounder, more narrow appearance to the breast, which not everyone appreciates. 

I tend to look for not only soft tissue asymmetries (nipple position, volume discrepancies) but also bony chest wall differences in the consult.  It's always easier to explain to a patient preoperatively, why we recommend different volume fills, rather than post facto.  Good luck.

Saline breast implants are manufactured with a fill range depending on the size of the implant, and the particular manufacture. For example, the implant may be manufactured to accept a volume of 350cc plus 50cc saline. Any fill within the fill range should allow the implant to perform well, remain soft and smooth, and wear according to design and warranty. Implants have been extensively studied, both saline and silicone gel implants, and carry approval by the FDA based on recommended labeled use.

Over filling a saline breast implant to 'improve' the performance or reduce rippling can introduce differences in softness, produce traction ripples along the implant edges, and may affect implant warranties. We feel it is best to use the implants as they were designed, and accurately fill them within the fill range specified. This should give you assurance that your saline implants will look well and feel well.

Best of luck,

peterejohnsonmd

I would ONLY recommend to fill to max as per the implant companies guide lines because if over filled than your warranty can be refused. Yes the rippling is better the more it is filled, so you and I are in a catch 22 situation. I fill just to the max.

From MIAMI Dr. B 

All breast implants suffer from one major failing; They have ripples. These are seen MORE in Saline filled implants than in silicone gel filled breast implants. The less saline is placed in the implants, the MORE the ripples are obvious. As a result, saline breast implants should be filled FULLY and never be under-filled. However, adding a much greater amount of saline to the implants will make them harder AND worsen rippling around the implant edges.

Filling the implants to the max fill volume is usually recommended.  Some surgeons fill them even more to minimize rippling.  If you have alot of breast tissue, you may not even feel the implants.

The look and feel of saline-filled breast implants has much more to do with getting them sized correctly and positioned correctly along with the degree of tissue coverage over them than the fill but I also include that saline-filled breast implants have to be be filled correctly. This means they have to be filled to at least their minimum rated volume and no more than 10% more. If they are filled below rated volume or above maximum rated volume they are not only potentially outside of warranty but you are more likely to have palpable or visible rippling. 

No one really has objective data on filling saline implants within the rated volume (minimum fill to maximum of 10% more). There is no data I'm aware of that filling beyond the 10% maximum improves anything and even within the proper fill range i don't see any consistent differences in thousands of cases. A subjective study to address the issue would have to involve the same patient with minimum fill on one side and maximum fill on the other (done for volume difference reasons) and try to see if there is a palpable difference.