What is the Maximum Size Implant That Can Be Placed Safely Behind the Muscle for Silicone Memory Gel?

Question

What is the maximum size implant that can be placed safely behind the muscle for silicone memory gel? Also I know that a cc is a cc but in saline implants have a different shape and appearance compared to silicone memory gel. I had  saline implants 375cc went to silicone 500cc but they seem smaller is this possible?

Bradley Bengtson, MD, FACS · Answer

I am a firm believer in Tissue Based Planning principles.  There is a growing group of plastic surgeons across the world that believe a 30% reoperation or revision rate 3 years after surgery for: size change, poor position of the implants, stretching of the skin etc is way too high.  If a breast implant chosen is based individually and in a customized way to fit each patient's breast, based on a few basic measurements and assessments such as breast width, stretchiness... and an implant is designed to fit in this range, the results are very consistent, full and natural and do not produce stretching or problems and can lower the revision rate to 3-5% at 3-5 years.  If any implant size is chosen, eventually it will place tto much pressure on the breast and skin and thinning of the tissues, increased malposition, wrinkling and rippling etc may occur.
You are correct most patients and even some plastic surgeons do not understand that saline weighs slightly more than silicone, not less.  In addition a saline implant is filled in surgery and does not include the weight of the shell of the implant...verses a a silicone implant that is prefilled and its' shell is included in the weight...so when I replace a 300cc saline implant filled to 330cc's it actually weighs 350grams/cc's so we need to replace with a 350cc implant just to get back to baseline.
Finally the most common misunderstanding in choosing an implant size is that implants come in 30-40cc increments...patients cannot really tell the difference inside the body, particularly submuscular, between a 300 and a 360cc implant although 360 sounds a lot bigger.  We have to add 100-150cc before you really begin to recognize the difference.
Personally I rarely place implants, even in revision patients > 500cc...ususally this outweighs the tissues and further problems can occur.  To directly answer your question, a 500cc implant is certainly larger than 350, but if you had prior saline implants your implants probably weighed 370-380cc bringing them closer to 500cc/grams.  Most patients can tell between implants 100cc or greater...if your weight has changed this can also affect your breast size.
Hope this helps.

Sanjay Grover, MD, FACS · Answer

The maximum sized available silicone gel implant available is 800 cc. You can get slightly larger with a saline implant. However, you should not choose a certain size without being evaluated by a plastic surgeon to determine if it is the apprpriate size for you based on your chest and breas dimensions as well as condition of your skin envelope. You say you feel that your 500 cc implants are smaller than your 375 cc saline implants. One possible reason may be that you have different profile implants. You may have had a lower profile implant before and now have a higher profile implant in which has more projection but is narrower.

Armando Soto, MD, FACS · Answer

Hi there,
Generally, I believe that implants should be chosen based on a patient's anatomy and the implant dimensions.  If you are interested in a more unnaturally large breast contour, certainly larger implants could be placed, as long as you understood the aesthetic outcome likely, and the longer term risks of implants that are larger than recommended, such as the risks of skin thinning and stretching (requiring a subsequent breast lift procedure).
In this case, the limitations would be the expansibility of your skin and the upper limit of implant manufacture. The largest readily available gel implant is filled to 1000cc, but a larger one may be custom made.

Farbod Esmailian, MD · Answer

The largerst silicone implant made by the company that I personally use is 800 cc.  And that is the memory gel.  Now there are companies out there that custom make implants as well.
As far as how large one person can go strictly depends on the patients body habitus, measurements and so forth.  So impossible to tell how large you can go without an exam.
As far as silicone and saline equivalent, you are right a cc is a cc.  It also depends on what time of implant, some have more projection than other given a set cc.  So what may appears larger may simply be that the saline implant may have had more projection than the silicone implant, which may be wider.
Hope that helps.

Tom J. Pousti, MD · Answer

It is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" 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 press 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.
	The silicone gel implants also sits differently on the chest wall and so it may look "smaller' when compared to a saline implants - the projection will be less.
	I hope this helps.

Bahram Ghaderi, MD · Answer

There is no way to say a maximum cc for an implant size. The size should be based on your chest dimension, skin tone and other body type factors. Your surgeon can go over these issues with you during a consultation. Getting the biggest implant possible is not always the best idea. There are definite down sides to a larger implant than your body can tolerate. Sizes are very individual.

John P. Di Saia, MD · Answer

Hello,
Breast implant sizing should be more dimensional than volume-based, in my opinion at least. Looking at a woman's chest wall, the breast has a diameter (the distance across), a projection (the distance outward), and a height. Going too far above certain maximums here leads to breasts that look kinda weird. There are shapes that change these numbers for a given volume.
This is really something best discussed between surgeon and patient before surgery. I start at consultation.

Jeffrey Zwiren, MD · Answer

It is possible that the change in size that you are noticing is actually a change in shape.  How does your breast fill the bra following the use of a larger implant?  A change of 125 cc should have taking you up about 1/2 cup size.  In my experience, when a patient desires to be a larger size and we have to use a new implant I usually want at least a full cup size difference to be present.
It is important that you make your desires known to your surgeon.  Pictures of what you want to look like are a big plus.  I never allow a patient to say, " I want to be a full C." It is hard to know exactly what they are talking about.
Most of the early revisions for breast augmentation surgery are for size problems.  It is expensive to make this mistake and it all comes down to communication.  You have to make your desires and expectations clear in order to get the result that you were expecting.  No one wants a disappointed patient.  Too big, too small, or just right is an individual choice.  Pictures help to make your point clear.

Stephen A. Goldstein, MD · Answer

Mentor Corporation manufactures the MemoryGel breast implants. With respect to size, there really is no limit as custom implants can be obtained through you plastic surgeon.  However, I must emphasize that common sense must prevail; don't assume that bigger is always better! Implants that are too large may upset the natural beauty and balance of your figure. The appropriate choice of implant size and shape does not need to be complex as it should be based on your physical dimensions and proportions. A potential breast augmentation patient needs to include in her decision process factors beyond just appearance, looking at her physical activities, lifestyle, hobbies, and vocation. 
In summary, it is best to see a board certified plastic surgeon that is experienced in breast surgery. Do not be in a rush, and be prepared to engage in thoughtful dialogue and discussion. After all, it is all about you!

Daniel Sherick, MD · Answer

The decision about implant size depends on many factors.  The size of your chest, body type, base diameter of your breast, and skin quality all help to determine the "optimal" size for you.  This size might be very different for another woman.  There are also many ways to help you to determine what implant size would fit you well.  Some plastic surgeons have "sizers" in their office that they will fit into different size bras so that you can begin to see what kind of a change you would get with different size implants.
Other ideas are for you to use water or rice in sandwich baggies in a bra of your choosing at home, and then try on different kind of clothing to determine what looks best.  Sometimes, if a woman is having a very hard time deciding on size, I have her bring in the bra she would like to fit into after the surgery, we sterilize it and use it to size her in the operating room.  In your case, you may be noticing a change in shape, more than a change in size.
I have had a number of patients swap out saline implants for gel and have the same impression that you have.  Typically these are patients who loose some fullness  in the upper part of their breast as the implant in replaced in a more "natural" position.  Hope this information is helpful!

What is the Maximum Size Implant That Can Be Placed Safely Behind the Muscle for Silicone Memory Gel?

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