Any Complications with Going Too Big?

Question

Hey realself army! On September 19th, I'll be flying out from Scottsdale to Miami for my breast augmentation! (Eps miami). I am 5 foot 2, and 110 pounds... my current bra size is a 32 B. Do to my small frame, I have chosen silicone implants instead of saline to eliminate rippling. I am going for 500- 525ccs, which is quite large, I'm expecting a DD as the result. Can someone please tell me if there are any added complications when using a big size on a small frame during surgery (not post op)?

Stephen Bresnick, MD · Answer

A woman desiring very large breasts for the body frame should think carefully about this choice.  I responded to this question because I assist many patients in the adult film business and have quite a bit of experience with the placement of large breast implants.  I spend quite a bit of time with my patients educating them on the issues likely to be encountered with this choice and what to expect in the future. 

	At surgery, more dissection and space is required for placement of large implants.  The nerves supplying sensation to the nipple, areola, and skin are stretched more with large implants, and sensation change is more likely.  There are more risks for stretch marks, and certainly a longer recovery period on average.

	After surgery, patients should expect, on average, that the implants will drop more.  The breast tissue will thin, sometimes quite a bit.  Even with silicone gel implants, some implant rippling and folds may be visible if significant tissue thinning occurs.  Bottoming out of the implants is more likely.  And if that is not enough, taking out the large implants in the future frequently requires that a lift be done to remove the excess skin which developed from the implant stretch of the breast skin.

	My patients are pleased with large implant augmentations, and are educated regarding these issues.  They understand that they may need more work in the future, especially if they change their minds later about size and want to go smaller.  They understand that the tissue will thin and the implants will likely drop.  They are encouraged to wear great support bras most of the time.   I hope this helps you understand some of the problems of large implant augmentation procedures.

	Best wishes!

Armando Soto, MD, FACS · Answer

Hi there-

	While the implants you are considering may give you the immediate appearance you think you want, there are definitely well-understood and negative consequences of using larger implants.

	The larger the implant, the more it will stretch and thin the breast tissue and skin over time, and the heavier it is- so the more it is affected by gravity. This often means that women who have larger implants are more likely to need more procedures over the course of their lifetimes to keep their breasts looking good, and that those procedures will result in increasingly less satisfying outcomes.

	If you have thought this all through and you are committed to the appearance you will achieve using the implants you describe, there is nothing wrong with proceeding in this fashion- but remember that the choices you make now will have consequences for you for many years to come.

Michael Burgdorf, MD, MPH · Answer

Congrats on deciding on breast augmentation. A couple things about your case make me concerned: 1. That you are flying cross country for surgery: While this is certainly acceptable (as I have out of town patients as well), I would stress that post-operative care is important. I would recommend staying where you have surgery for at least a week to ten days and then make sure there is a surgeon willing to see you in your home town, if needed. 2. Size selection: This may have an increased risk of malposition to the bottom or side and may show rippling, even with gels. Depending upon your skin stretch, there may be a tendency for your post-operative result to look more"augmented" than natural. During surgery, the risks are not so dependant on size of the implant, but on your overall health and technique of the surgeon. I'd recommend you visit a board certified plastic surgeon for an in-person consultation. Good Luck.

Kim-Chi Vu, MD · Answer

There are potential complications with having the implants "going too big".  In general, the factors that determine what type of implant or what size of implant are based on the measurement of your chest wall as well as your breast diameter.
	That should help give you the reference as far as what is the base diameter for the implants, then depending on whether you are going with a moderate profile or a high profile will influence on what type of volume you should have to give you the proportionality of your body.  If you go with the "too big" implant you may potentially cause stretching of the skin tissue, or parenchyma.If this occurs, then ultimately in the future you may potentially have some problems with stretching of the skin, causing laxity, which may potentially cause stretch marking as well as potentially having causing nerve damage which results in numbness to your breasts as well as to the nipple.  My recommendation is to always be cautious and be conservative, it is easier to go to small and then increasing in size in the future if necessary.  It is very difficult to go too big and then convert to a smaller size later.

Tripti Burt, MD · Answer

There are more complications related to larger implants than using smaller or moderate sized implants. Your selected implants are large for your frame. This will look wonderful in the shorterm but with time, the skin will thin, the implants may have some rippling, and you make develop more droop more quickly. Silicone implants are lighter than saline implants so the droop and thinning process will be slower hopefully!

Peter E. Johnson, MD · Answer

Problems do ocur with a very full implant on a small frame, and much will depend on the available breast tissue to cover the implant. Over time your breast will thin and the implant may show through and appear round and artificial, and even a gel implant can have a visible fold or ripple. Make sure you think it through, and show your surgeon the look you wish to have, and with luck things will work out well for you.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Yes,  increased rates  of complications may arise  if a plastic surgeon tries to use breast implants that are too large for a specific patient's frame.  Some of these complications may include an increased risk (for example)  of rippling ( for example if the breast implant is more palpable on the sides of the breast),  implant displacement/malposition where the breast implant ends up in a undesired location ( for example, bottoming out, symmastia, lateral displacement).

	 I would suggest that you be very careful; both you and your plastic surgeon should emphasize safety and avoidance of complications when deciding upon breast implant size…

	Best wishes.

Scott L. Replogle, MD (retired) · Answer

It's not that 500 cc implants are too large for your frame, it's that they are too large for your breasts to accommodate in one procedure without serious risk of unexpected and unwanted outcomes both short term and long term. It's like your foot being a size 7 and insisting on cramming it into a size 2 shoe. You might get away with it and the shoe stretches to accommodate your foot without tearing or distorting but it doesn't make sense to try it when a proper sizing works predictably. 

	The proper way to size an implant is to measure the width of your breast across the widest point upright and with your arms down. About 3/4 of a cm is subtracted to allow for your skin and in silicone gels, both Mentor and Allergan have a high profile implant that will fit your breast and maximize the volume gain but not stretch or distort it or require a pocket outside the confines of your breast, all of which lead to potential problems and unpredictable outcomes. 

	Unless your breast width is unusually wide or narrow for your chest circumference, the effect of a properly fitted high profile implant below the pectorals muscle for the upper half coverage will be a gain of about two cup sizes. This would be a D from a B cup but not a DD cup. If you want to go bigger then consider exchanging the implants for somewhat larger ones after your tissues have healed and accommodated the first implants. 

	I would also agree with the response regarding out of town surgery. I require patients to be in the area for a week after the surgery at minimum.

Stuart B. Kincaid, MD, FACS (in memoriam) · Answer

If your surgery is being done by a certified Plastic surgeon everything should go smooth. You are going with a pretty size implant expect to be sore for a longer time then a patients not going as big. If you’re going out of state make sure you will have adequate after care for post-surgery that is extremely important.

Any Complications with Going Too Big?

Answers (9)

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