500cc too much for one-stage augmentation and full lift? (photos)

Breast augmentation with lift is as hard as it gets in aesthetic breast surgery. The two components of the operation work against each other: if we do a lift and want it to stay up, why would we place a weight (i.e., an implant) in the breast? The larger the implant the faster will the lift stretch out. Moreover, no one knows how to fix the underlying problem, which is the quality of the skin. No matter how tight the surgeon makes the breast in the operating room, the patient takes home the same damaged skin. Your photos suggest your skin is severely compromised. I would be concerned that 500cc devices would prove far too heavy for you, and that your lift would stretch out very quickly. I recommend you reconsider your size choice. All the best.

Thank you for your question and photographs. I think that your concerns are valid. A 500cc implant is large and your photos demonstrate skin that has lost its natural elasticity. You're at an increased risk for re-stretching. I would have a frank discussion with your surgeon about the risks of a large implant. In my office, a patient with your anatomy, would be offered a two stage augmentation and breast lift (mastopexy). Stage I: full breast lift. Stage II: 3-6 months later, conservatively sized breast augmentation to add volume and give more fullness at the upper pole (top of the breast). If you have concerns about your treatment plan, have several consultations with experienced plastic surgeons to hear all of your options.

Thank you for your pictures and questions. I think that a 500 cc implant is a large choice for you. That does not mean it is a bad choice, but it is certainly large and you will be prone to all the downstream effects of choosing a large implant. In addition, your skin appears to have a strong propensity to stretch and this would worry me about such a large implant. In regards to doing the implant and the lift in one stage, I tend to be on the conservative side and I would not advise it in your case. With your stretchy skin and that large and heavy of an implant, I think a one-stage procedure in you is very high risk. I would advise having a lift first and let that heal. About 3-6 months later, then I would try on sizers all over again and approach your case like a standard augmentation and then see what size you ultimately want once things are lifted to a new position. You might find that when the position and appearance changes, your goals in terms of size will change. Hope this helps!

Dear Herricr,
Thank you for your question and photos. Based on the photos, I believe that 500cc will be too large for you, will make it difficult for you to find well-fitting clothes, and will eventually cause significant sagging. I advise you to try sizers in your surgeon's clinic, or try the 'rice test' at home to determine the proper size. Best of luck!

if you have had an opportunity to view yourself with external sizers (around 450cc).  With your look, I would be utilizing a de-epithelialized inferior based flap to fix your fold and provide additional coverage of your implant on the lower pole.  Choose your implant for the look you want.

First, it has been shown that going with big (or with any implants for that matter) at the same time as a full lift is fraught with increased complications for many reasons, not the least of which is the inherent conflict of stretching and tightening tissues at the same time. Where else would colliding these forces be a good idea? Second, your photos show a rather poorly elastic starting point which means that you honestly cannot achieve a high full round look. Over time, these bigger, heavier implants, even under the muscle, will settle down to the lower pole and the upper fullness will be lost. That "look" can only be achieved in folks who are built tight or in a 2-stage implant process where the start is with a modest implant to build the scar pocket internally and then switch to a big implant 6-9 months later. I hope your chosen surgeon has been forthright with what your starting point means or you are heading towards disappointment.

I assume you have tried on sizers and like the look of 500cc. This is a larger implant, and there is some increased risk of stretching or bottoming out over time, particularly if your skin and tissues are thin and damaged as yours appears to be. Subpectoral implants will hold their position better than above the muscle, but that is still no guarantee. Textured surface implants may also hold their position better than smooth. Also, due to the extent of your breast sagging and skin damage, I believe that you are at higher risk for restretching, which can lead to your breasts hanging off of your implants. Although patients always want to have implants and a breast lift done at one stage, my preference would be to do the best "anchor" or inverted T breast lift (without compromising the lift by performing it over a large implant), allow it to heal well, and 3 months later place the implants while retightening the skin through the inframammary incision as the damaged skin will undoubtedly have relaxed somewhat by that time.

The volume is quite a bit for you , but that may meet your needs. My worry would be the implant is awfully big when doing a big lift (which you need) which significantly raises risk of skin dying at the time of the lift.