Few topics generate as much discussion in breast augmentation as implant size. Why choose according to your height, build and tissue, rather than simply the volume you want? And why avoid very large implants? Let me explain.
A principle borne out over time
The larger an implant is relative to a patient's body, the less likely the result is to hold up over time. That is why planning systems use objective measurements of the chest and tissues — including breast width, skin thickness and elasticity — to select the implant. Surgeons who use these systems report much lower revision rates than usual. This is the approach I use in my practice.
Gravity does not make exceptions
Gravity always acts on the breasts, and a large implant adds weight. The effect is especially noticeable with implants over 350 cc placed directly behind the gland. Even a large implant behind the muscle can descend over time along with the surrounding tissue.
Two problems with very large implants
Pocket size. A large implant needs a pocket wider than the breast's natural footprint. Its edges may be visible at the sides, and folds in the implant may show through the skin. This can be apparent from the outset.
A very high profile. Large implants often project far forward, putting constant pressure on the surrounding tissue. Over time, that tissue can thin, leaving an increasingly visible implant with less natural coverage. This can also affect breastfeeding and sensation and, in extreme cases, deform the chest wall. These changes develop over the long term.
Why do we see so many implants larger than 500 cc?
Many images in the media and on social platforms come from countries where women are, on average, taller and have broader chests. That aesthetic also prioritizes volume over proportion. Very large breasts can cause back pain and limit movement.
In my practice, I rarely use implants larger than 350 cc. A tall patient with a broad chest may need a slightly larger implant, but always within what her body can support.
What is not always explained
An oversized implant may look good for a few years. Over time it is more likely to descend and require further surgery: implant replacement, sometimes with a lift and additional scars. Every reoperation adds risk, including capsular contracture. I discuss this in detail in the article on implant removal.
What matters most
Cosmetic surgery should put your safety first, minimize the need for further operations and give you a lasting result. Choosing an implant that suits your body is the most important decision in achieving that.
References
- Tebbetts JB, Adams WP. Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg. 2005;116(7):2005-2016.
- Adams WP. The process of breast augmentation: four sequential steps for optimizing outcomes for patients. Plast Reconstr Surg. 2008;122(6):1892-1900.
- Tebbetts JB, Teitelbaum S. High- and extra-high-projection breast implants: potential consequences for patients. Plast Reconstr Surg. 2010;126(6):2150-2159.