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Can Breast Implants Be Too Big?

Some of the visitors of this web site have asked if I have anything against big breasts. This seems like a silly question. In my professional opinion, there is a limit to how large a woman's breasts can be made without having an unacceptable risk of complications. Some surgeons treat the patient like a patron at a sandwich shop. I do not. I try to limit problems as much as possible. Reviewing cases for the California Medical Board over the last two years has taught me that my own complications are mere shadows of those that some other California surgeons are facing. It is gratifying to see that my philosophy is effective.

-JPD

The bottom line here is that the reasons for limiting size in implant surgery are practical.

I am not interested in making this:

I didn't do her procedure. These implants are so big that the skin envelope can't accommodate them. She has about a 100% chance of needing more surgery over her lifetime. I wouldn't feel right about deliberately putting any patient of mine into that position. I am a surgeon; not a short order cook.

That doesn't mean that large breasts cannot be made from small ones. It just means that if you don't want problems there has to be a limit. The woman below is one of my patients. She has very full breasts.

Before Breast Augmentation
Before Surgery
 Four Months Following Cosmetic Breast Surgery
Four Months Following Surgery

She has large breast implants, but not a cavernous cleavage. Her skin envelope isn't tightly adherent to her implants. She looks large but her breasts can bounce a little when she walks. They are soft. These are certainly larger than those of my average patient, but they don't look "too fake." Women that want to be much larger than this probably should find another surgeon. These are saline-filled implants placed "under the muscle." Saline-filled implants can look and feel natural as long as the soft tissue coverage is adequate. They also have a lower potential for hardening over time...about a third of that seen with silicone gel filled implants.

Women that want really large breast implants (3 cup size enlargement) should accept that they will likely experience some complications. They will have implants that are more easily felt and seen, a higher risk of contracture (breast hardening/distortion), rippling (visible "dents" from implant wrinkling that are visible through thin skin), droopy breasts (gravity works on larger breasts more than on smaller ones) and a higher chance of needing/wanting additional surgery later. As long as the patient is understanding of these issues and the requested breasts aren't truly enormous, I will offer the patient surgery. There is the risk for these problems with smaller breast implants. It is just that the risk gets larger as the implants do.


Please note that this information is offered freely to individuals considering cosmetic surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent.

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©1996-2006 John Di Saia, MD... an Orange County California Plastic Surgeon       Dr John Di Saia, an orange county california plastic surgeon