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Breast Augmentation: Bigger Isn’t Always Better

Breast Augmentation with oversized implants is not an oxymoron, even n Beverly Hills. Yes, it happens, and it happens all to often in the City of Angels. Recently in the office, I saw a young woman who had a breast augmentation about a year ago in Beverly Hills with 750 cc breast implants. She was unhappy about the shape of the breasts. She reported having an infection in the right breast shortly after surgery. Specifically, she was unhappy because her nipple positions appeared to be droopy. Upon evaluation, it was clear that a few things were going on. Number one, she probably has some component of capsular contracture in both breasts. Capsular contracture is when the scar tissue around the breast implant hardens. It can distort the implant and make it ride high on the chest wall. One strong risk factor for capsular contracture is prior infection. Another risk factor is probably oversized implants. Correcting this presents a very large problem. For one, the skin envelope is already stretched out to accommodate the large implants. Two, to raise the nipple after a large augmentation with breast lift or mastopexy may just put the nipple areolar complex at risk for poor blood flow and total nipple loss and secondary necrosis, particulalry if the augmentation was ‘over the muscle’ (subglandular). This is a disastrous complication as one can imagine. To tackle this problem the safest approach in this patient will be to remove these excessively large implants replacing with smaller ones, and lower the contracted breast folds to help center the implant around the nipple. We would then raise the nipple just about 2 cm with a periareolar mastopexy (where the incision is strictly around the areolar complex). We would also have to remove the capsule (capsulectomy). I am publishing this post to remind potential patients that bigger is not always better. In fact, the bigger implants mean bigger problems. Anything over 450 cc will exponentially raise the complication during a breast augmentation surgery. Patients should know this before they decide to get such large breast augmentations.