Do Smaller Breast Implants Necessarily Mean Less Risks?

Question

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.

Navinderdeep S. Nijher, MD · Answer

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.

Jeffrey E. Schreiber, MD, FACS · Answer

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.

Steven S. Carp, MD · Answer

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.

Michael Law, MD · Answer

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.

George John Alexander, MD, FACS · Answer

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.

Donna Rich, MD · Answer

Smaller implants, in general, do not change the risks involved with breast augmentation. Very large implants can have deleterious results with atrophy of the skin, bottoming out and rippling over time. The most important point is that you are comfortable and trust your board certified plastic surgeon performing your breast augmentation.

David Finkle, MD · Answer

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

Herluf G. Lund, Jr, MD · Answer

Dear Genuine,  Great question!!!  You really have to separate implant problems into two groups.  Those potential problems that all implants no matter what the size can experience and those problems that are more related to size.  

	The larger the implants, the stress and force that is applied to the breast tissues that have to support the weight of the implants.  This can lead to more stretching and thinning of the breast tissues.  More bottoming out of the breast.  More palpability of the implant.  More risk of seeing the implant when looking at the breasts. Less of a natural breast movement and "flow" since there is less breast and more implant making up the breasts.

	Problems that can occur with all implants regardless of size include capsular contracture, implant failure, malposition, infection, etc.

	The key to obtaining a great and long-lasting result is to choose an implant size that will work with the breasts you have.  You need to select an implant that will match your breast dimensions-go beyond the dimensions and you will have a higher risk of seeing the implants including rippling. Go too small and you may have a lack of fullness to the breasts.  You need to match your soft tissue characteristics-very stretched and thinned tissues from pregnancy, weight loss, nursing, etc. cannot support as much weight as more robust breast tissue.  This is why you need to discuss this with your plastic surgeon who will help you decide what size will be optimal for your breasts.  The point of optimal is not that it may be the exact ideal size you were thinking of but it will be the size that will have the best chance to give you a beautiful and aesthetic result and a long lasting result.  Good Luck. I wish you much success.

Peter A. Aldea, MD · Answer

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 E. Johnson, MD · Answer

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

Do Smaller Breast Implants Necessarily Mean Less Risks?

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