Background: Breast augmentation surgery using implants remains one of the most successful body contouring procedures over the past fifty years. The immediate and sustained increase in breast size offered by an implant is the reason for its success and popularity. Because it is an implant dependent aesthetic procedure, it is not a perfect operation as it is subject to the many potential issues that an implant in the body incurs. But despite these drawbacks, and the lack of an equally successful non-implant alternative, it will remain a highly sought after body contouring procedure into the near and far future.
While there are numerous factors to consider when contemplating a breast augmentation, the choice of the implant and the resultant size it creates is always at the top of any patient’s consideration. Breast implant manufacturers offer a wide range of fixed volume silicone implant and volume-adjustable saline implants. Such off-the-shelf- options will work for the overwhelming majority (99%) of women. The sizes range from 150cc to 800cc (silicone) and 960cc (800cc saline overfilled to manufacturer’s recommendations) While the concept of size is subjective and dependent on the body in which it is placed, it is fair to say that implants in the upper ranges of 800cc would be considered ‘large’.
A select few women do desire larger volumes that exceed the large category and by volume would be somewhere above 1000cc. This is what I define as extreme large breast augmentation. This can be currently done in the U.S. with an overfilled saline implant. Although the manufacturer’s recommended volume overfill limit is 960cc (from an 800cc implant) clinical experience and silicone shell elasticity have shown much more of a volume overfill can be achieved.
Case Study: This thin young female sought to improve a prior breast augmentation result. It lacked upper pole fullness and and was not the volume she desired. Her existing breast implants were saline filled to 600ccs placed in a partial submuscular position through inframammary incisions.
Under general anesthesia an inframammary approach was taken using her existing scars. A subtotal capsulectomy was performed, releasing the upper pole and removing a large amount of capsule in the upper half of the breast. 800cc moderate plus saline implants were placed that were inflated to 1,150ccs on each side. Her result shows much fuller and rounder breasts that occupied a central position centered under the nipples without too much side projection.
Extra large breast implants are overfilled saline devices that exceed the manufacturer recommendations. Presumably the manufacturer sets their recommended fill limits based on the known limits of safe lastic stretch of the silicone elastomer shells. For all saline implants this is 20%. It is clear that much more saline can be added without any immediate risk of shell rupture often up to 1500cc to 2000ccs in my experience. This represents 1.5 to 2X the standard fill volume of the implants. What that means long-term in regards to an increased (rupture) rate of the implant is not unknown. At the least it will make the manufacturer’s warranty void because the manufacturer’s maximum overfill recommendations have been exceeded.
Patients that are undergoing extra large breast implants should also understand that they are stretching out the breast tissues considerably. While this may have the current desired size result in the immediate and short-term, should the patient desire to downsize their implants in the future they will likely need skin removed to tighten the soft tissue kind around a smaller implant size.
Highlights:
1) Extra large breast implants refer to any implant size that exceeds what can be achieved by standard options off-the-shelf whether it be silicone or saline.
2) Any breast implant that exceeds the volume of 800cc to 960ccs would be considered extra large.
3) In the U.S. extra large breast augmentation must be done using overfilled saline implants.whose projection vs base diameter must be considered carefully.
Dr. Barry Eppley
Indianapolis, Indiana