Do Smaller Breast Implants Necessarily Mean Less Risks?

Do smaller breast implants necessarily mean less risks? Like less chance of rippling, leaking, longer lasting, less sagging, etc? I want natural results to simply look more proportionate in my clothes. I currently have A cups and would like full B cups with saline - I think about 210cc. I have a feeling I may want to go larger for full B cups, but I feel the larger the implants, the more risks are involved.

Doctor Answers 13

Breast implants:Smaller Less Risks?

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Thank you for the question.  

Although I think very large implants do carry higher risks of complications than smaller breast implants  I believe that the range of breast implant sizes you are discussing  in your question do not change the risks that you take. I think the greater risk, in your case, may be that you will be dissatisfied with the breast size you end up with (if you're not careful).

 You may find the following words of advice helpful.

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.


Small vs. large breast implants

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Choosing the right size of breast implant can be a difficult decision and there are no steadfast rules. Smaller implants should cause less distortion of the tissue and therefore should have less risks but more important than the implant size is the decision making process in choosing which implant to use. Picking the right width and profile can be just as important in trying to prevent these issues. Also, the surgery itself and how it is performed is more likely to cause bottoming out and sagging than which implant you have. At the sizes you are looking for, I think you have reasonable expectations and just make sure you and your surgeon are on the same page about what you are looking for and you should do fine.

Implant size does not change surgery risks

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This is a very good question, the converse of this question is actually even a better question; Do larger implants have higher risks?

There are two parts to the answer to these questions.  The first part is the risks and potential complications related to the operative procedure itself, and the second is the risks and potential complications related to the implants in the long term.

Let's talk about surgical complications first.  The immediate risks inherent in this procedure are bleeding, unfavorable reaction to medications or anesthesia, pain, time off of work, loss of sensation to the breast skin or nipple/areola, infection, loss of implant and other rare complications of surgery such as thrombophlebitis, pneumothorax or even death.  None of these risks are changed by the size of the implant placed.

Long term risks and complications associated with implants include: abnormal scarring, capsule formation, asymmetry, pain, wrinkling and rippling of the implant, implant palpability, thinning of the tissues around the implant, distortion of the implants, leaking or rupture and the need for further surgery.  The majority of these complications are not influenced by the size of the implant, but some are:

  • Tissue thinning around the implant, if you have very thin tissue and a large implant is placed, the chances of the tissues surrounding the implant becoming thin and showing more wrinkling and rippling is higher.
  • Wrinkling and rippling (see above)

Having placed over 10,000 implants, I have seen all the complications with big or small implants, saline or silicone, above or below the muscle, immediately after surgery and long term (20 years later).  It is important to talk to a Board Certified plastic surgeon whom performs implant surgery frequently to determine what the best choice is for you and what the major risks and potential complications are specific to your surgical procedure.

Good Luck

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 83 reviews

Breast implant risks

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Thank you for your question.  Smaller implants don't carry less risks than larger implants, but they will most likely cause less sagging of your breasts over time as they are not as heavy as larger implants.  All in all, breast augmentation is a very well tolerated surgery with miminal risks as long as you're healthy and in good shape.  I think your implant size goal is very reasonable, and It will help to increase the volume of your breasts and improve the shape without being too large.

Implant Size and Risk

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In general the include size does not carry any greater surgical risk.  However, large implants do have a greater risk of issues long term.  In addition, if the tissues are poor quality, the risk is greater.  The primary concern is thinning of the skin, bottoming out, traction rippling and others.  It is important that the implant match your anatomy.

Steven S. Carp, MD
Akron Plastic Surgeon
4.6 out of 5 stars 32 reviews

Do Smaller Breast Implants Necessarily Mean Less Risks?

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Yes - if we were to reduce and simplistically distill the argument to a discussion of implant volume, smaller (lighter) implants ARE associated with less problem than larger breast implants.

BUT - that is NOT quite the cause. Great looking augmented breasts are created when the implants chosen are fully covered by the available breast tissue. Going with larger (wider, heavier implants) causes wasting away of the available breast tissue with visibility of the implant shell, with faster stretching of the breast skin (creating stretch marks, wider stretched out areolae) and faster sagging (creating questions such as : "Why did I lose my upper pole fullness a few months after my augmentation with 500cc implants???" in the uninformed)

To sum it up - go with the smallest implants that would make you happy.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon

Smaller implants, smaller risks

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Generally it is true that smaller implants will produce less breast tissue thinning, less traction ripples, less sag, less change in nipple sensation. There is is range of  'small' which also depends on the size of your breast, how much tissue is available to cover the implant. In reaching a B-cup any implant will be within the safer range so consider the size or look you want and go for it. And the longer lasting less leaking, unfortunately a no here.

Best of luck, peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Small Breast Implants

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Overly large breast implants come with a whole host of problems. However, careful consideration must be paid to small breast implants as well. The size, shape and placement if the implants will dictate how natural (or unnatural your breast implants look. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Smaller breast implants

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Smaller breast implants typically result in fewer long term problems.  However, in order to get a good result, the implant must be appropriately sized for your body.

Dennis Dass, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 184 reviews

Do smaller implants = fewer risks?

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Very large implants, especially on a petite woman, may indeed cause more risks.  A larger implant is heavier, therefore it may be more prone to stretch out the skin and cause more drooping of the breast over time.  If you are trying to decide on sizes within the 200cc-300cc range, it is unlikely that this would be a significant issue for you.

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.