While there many important issues to consider in breast augmentation, the size of the implant is one that women spent the greatest amount of time pondering before surgery. There are a variety of implant sizing methods and they all have their merits, but the reality is that breast implant sizing is not an exact science. No patient can really know for sure how they like the implant size selection until they swelling goes down and they have ‘worn’ it for awhile.
Women for breast augmentation usually want an implant size that looks natural, fits their body frame and does not stand out as their most notable feature. What that implant size may be is open to interpretation and highly subjective. But there are women who do want to have large breast implants and their goal clearly is not to be subtle in the result and a natural look is not their goal.
Breast implants come in a wide range of sizes from 150cc to 800cc. Because silicone implants are prefilled, their maximize size is 800cc volume. Saline implants, however, are alway overfilled and their volume can well exceed 1000ccs if desired. Considering these options in breast implant sizes, a large breast augmentation is going to be in the range of 600cc to 800ccs. For some women the volume may be much more.
For a variety of reasons, many plastic surgeons are opposed to larger breast implants. Such opposition is based on two basic and understandable reasons. Large breast implants are associated with a higher rate of complications such as loss of tissue support (bottoming out), implant asymmetries and deflations. (saline implants) The fundamental teaching in plastic surgery is to not place implants that exceed the ability of the tissues to support them long-term. The second reason for objection is the long-term consequences of the stretched out breast tissue. Large implants do deform the breast tissue irreversibly and their removal or reduction in size in the future will necessitate major breast lift surgery and its associated scars.
But breast implant size is a very personal decision and as long as the patient has been educated as to its potential consequences, large breast implants are a patient’s choice. The most common women who seeks large breast implants in my experience is the one who already has breast implants. They may have had them for years and now desire a much larger size. They may have had children or lost weight and their overall breast size has gotten smaller and a lot more volume is needed to fill out the loose skin. In these cases it can take a lot of implant volume to adequately expand the stretched out breast skin. In many ways these women are much more ‘qualified’ for large breast implants because they have a better frame of reference.
Some first time breast augmentation patients do seek large breast implants but they are far less common. Big for them might be up to 500ccs or so in small frames and 600cc to 700ccs in larger framed women. This is big for them given where they started but are not that big compared to women who are changing their existing breast implants.
The concept of large breast implants is open to interpretation but would be anatomically one where the implant width exceeds that of the the natural breast base width. While this may contribute to better cleavage it equally means that the side of the implant will protrude out beyond that of the chest wall.
Dr. Barry Eppley