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

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.

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. 

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.

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

Hello,Thank you for your question. Unfortunately you must be examined in person in order to determine the best approach for you. You areola and breast anatomy, plus measurements, plus the look you are after, will be factors to help your Plastic Surgeon recommend both the implant size and incision route. I recommend that you book a consultation with a board certified Plastic Surgeon to consider your options.All the best

Thank you for your question. Be sure to consult with a board-certified plastic surgeon to discuss what options would best help you to achieve your desired goals. Silicone implants come pre-filled, therefore a slightly larger incision is necessary compared to using saline implants. The diameter of your areola will determine if you are a good candidate for this approach. If you are determined to have an areola approach sometimes a Keller funnel is used to keep the incision smaller. Best of luck, Dr. Kludt

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

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!

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.

Thank you for the question. Much will depend on your physical examination (for example the size of your areola). In my practice, I like the use of the infraareolar incision both for first time breast augmentation patients and for revisionary breast surgery patients. I find that, especially with the use of the Keller funnel, that I'm able to use the infraareolar incision for all patients.  For example, even for a patient with an average areola size, placement of even an 800 cc silicone breast implant is usually not a problem.Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “very natural” or "C or D Cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.