What is the maximum CC's for silicone implants through an areola incision? (Photo)

I'm 26 5'2" 110lbs and have not had any children. Currently I'm a 32B and would like to be a full C or D. Will I be a good candidate for an areolar incision with silicone implants if I want 400 CC's minimum, and what are the risks with this type of incision?

Doctor Answers 14

Size is a matter of personal preference

There is no such thing as too large for you. You in fact have a perception of what you want to look like. The surgeon cannot tell you what you like. It is as ridiculous as them telling you what your favorite color is or picking out your new car for you. They can guide you, but if your perception and their rigid, non-scientific approach don't mesh, find another surgeon.

The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.

A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would.

HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.

There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular dual plane. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.

The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant.

The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.

San Antonio Plastic Surgeon
4.9 out of 5 stars 136 reviews

Breast Augmentation: Information

Dear Ms. Manickuh,

Thank you for your story and questions.
Unfortunately with out nude photos and a exam of your tissues I can can only comment based your story, however I hope you find my comments helpful.

1) depends on the size of your areolae
2)400cc will need a 4.5 cm. incision on a stretched areolae
3)areolar incisions have a slight higher incidence of internal scar formation (capsular contracture) than inframammary.

I recommend that you collect a number of "model" photos of your desired appearance and make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

I wish you my best and success,
R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Robert A. Hardesty, MD, FACS
Riverside Plastic Surgeon
4.9 out of 5 stars 100 reviews

Areolar incision breast augmentation

Thank you for your question.

The areolar incision is a perfectly reasonable approach to placement of a breast implant. There is no volume specific volume limit, however, the size of your areola may limit what volume will silicone implant may be able to be placed.
Alternatively, saline implants of any size can easily be placed through this incision.

Some studies have shown that the areolar approach can lead to increased capsular contraction and/or nipple sensation changes, however, this is controversial as other studies have not clearly shown a risk.

I would discuss your concerns with your board certified plastic surgeon.

Best Regards,
Dr. Stutman

Ross Stutman, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 6 reviews

What is the maximum CC's for silicone implants through an areola incision?

The answer depends entirely on the size of the areola. It is a very popular incision in my patients due to the very predictably good scar - it varies from a thin white line to invisible. If there is quite a bit of breast tissue it is better to use the incision in the fold at the bottom of the breast. Over 30+ years of practice I have not seen any significant negatives to the incision when properly chosen for the individual's anatomy. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Periareolar incision

The periareolar incision can be an excellent choice for breast augmentation.  The primary advantage of this incision is that it can hide well in the pigmented border of the areola for some patients.   The ideal patient has an areola that is large enough to fit the chosen implant, and does not have much of a crease or fold to hide the scar in.  The degree of pigment in the areola tissue relative to the skin is a factor as well.  In my practice I most commonly use this incision choice for a specific type of breast (or if the patient simply prefers it).

For most patients it is not my favorite incision, there are a few risks that are increased using this incision as compared to a crease incision.  If the patient produces excellent scars it hides very well in either location.  If the patient does not, having a poor scar around the focal point of the breast can be worse than the same scar hiding in the crease.    There is also an increased risk of capsular contracture, nipple numbness and scar depression leaving an indentation beneath the scar in this location. 

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 183 reviews

It depends...

Whether the desired implant volume can be inserted through the areolar incision depends on several factors:  #1  How large are your areola?  There is a tremendous variation in size of the areola, with the largest spread typically seen in women who have had children or significant weight gain.  #2 How distensible (stretchy) is the skin around the areola?  If you have minimal excess skin around the areola, there won't be much give in the tissues, and inserting the implant can be difficult.

The size of the areola is the primary determinant of the size of the implant that can be used, and whether that approach is feasible or not.  In certain cases, the diameter is so small that not only would it be very difficult to insert an implant, but simply creating the pocket might be impossible because of the poor view of the surgical space.

Lastly, the risks of malposition, reoperation, and capsular contracture are higher via the periareolar approach.  Those risks are not excessive, but definitely something to consider when choosing the incision location.  Furthermore, in patients who have what I call a "pouty nipple" - more breast tissue under the areola than typical - a scar placed along that border can lead to a worsening of that tethered appearance.

As always, the best advice will come from an in person examination from a Board Certified Plastic Surgeon.  Additionally, I always suggest patients look for membership in the state plastic surgery society.  You'll find a list of our Utah Members at the safeplasticsurgeryutah website.

Best of luck!

Brian K. Brzowski, MD, FACS
Ogden Plastic Surgeon
5.0 out of 5 stars 76 reviews

Areolar incision

 In my opinion, in order to use the areola to place large implants, the incision needs to be at least 4 cm in length on stretch. I found it useful in this scenario to use the Keller funnel as this allows for larger implants to go through smaller spaces. The advantages of the areolar incision include less visibility in pigmented skin, such as ethnic skin. I also believe that loss of feeling, especially just above the infra-mammary crease, is less common in the areolar approach. Some would argue however, that because we are transect breast ducts in gaining access to the sub muscular pocket, that the risk for capsular contracture is higher going through the areola that it is through the infra mammary crease.Seek out a board-certified plastic surgeon in your region to discuss the merits of this approach. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Areolar incision

Hello, the size of implant that can be inserted through an areolar incision depends on the size of the areola and features of the breast itself (amount of tissue, skin laxity etc).  If you seek an in-person assessment with a PS they will be able to explain the advantages and disadvantages in your case.

William Andrade, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

Given the right conditions, the maximum size implant that is manufactured can be placed through the areola if desired

The straightforward answer to your question is that an 800 cc implant, which is generally the largest size round silicone gel implant offered by the US manufacturers, can usually be inserted through a periareolar approach provided that the conditions are right.  That means that the areola is large enough in diameter (usually this means average size, it doesn't have to be huge or larger than normal), the tissues can accommodate such a large size, and a Keller funnel is used to insert the implants.  They can be inserted without the funnel, as I have done so for years, but it makes it technically easier and decreases risks.

With regard to the risks of the periareolar approach, the statistics show that there is a measurable increase in the incidence of capsule contrature when implants are placed with a periareolar incision versus under the breast, or inframammary.  This doesn't mean that we shouldn't use periareolar incisions at all - I do it all the time - we just need to acknowledge and accept this slight increase in risk.  Also I believe that there is perhaps a slight increase in the risk of sensory loss to the nipple with periareolar incisions, and although the studies haven't proved it, I inform my patients who have not yet had their babies that because we have to divide some milk ducts and glands to get to the implant space, we could have some loss or decrease in the ability to breastfeed with periareolar incisions.

Those are the general considerations.  What is best in your case will have to be determined with a careful evaluation and assessment of your goals and your breasts.  It sounds like you already have a decent amount of breast tissue if you're starting with a B cup, and getting to a full C or small D probably won't take a huge implant.  Thus, assuming that your areolae are of average diameter, I would bet that a periareolar approach would be technically feasible for you if you chose to go that route, even if you prefer an implant in the 400 cc or larger range.  Again, make sure you discuss all of your preferences with a board certified plastic surgeon who can properly advise you on all of your options and all of the risks.   In addition to being certified by the American Board of Plastic Surgery, the organization which certifies plastic surgeons, your surgeon should also participate in the Maintenance of Certification program administered by that board. This program requires that surgeons who participate continue to update their credentials and professional standing regularly, as opposed to practicing on a single lifetime certificate like those plastic surgeons who elect not to participate. To find further information about this program and any surgeons you might consider for your surgery, I suggest visiting these sites: abplsurg.org and abms.org. Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 87 reviews

Breast Implants/ Breast Augmentation/ Anatomic Gummy Bear Implants/ Silicone Implants/ Breast Implant Revision Surgery

I appreciate your question.

The size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the top (upper pole fullness).
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 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.