It is the perception in our society that the bigger the breasts, the better. However, when it comes to the interaction and soft tissue dynamics of the breast implant and the breast itself, studies have shown that the bigger the implant, the more problems you will have. Depending on the skin envelope and the soft tissue of the breast, the implant volume the breast can handle varies from patient to patient.
When a breast implant is placed through any of the incisions that we have described before, the soft tissue of the breast is stretched to accommodate the breast implant. If you choose an implant that is appropriate for your elasticity and breast dimensions, the soft tissue dynamic between your breast and the implant will be much better, increasing the longevity of your surgery.
So, what happens when we insert an implant that is larger than your breast can handle? First, you are going to have a more unnatural look, depending on your skin envelope and how tight your breast is. This is not necessarily bad, depending on your desired breast shape and size. However, if we follow patients over time who have implants that are bigger than recommended, we see a progressive stretching of the skin with loss of breast tissue due to thinning as the implant pushes on the breast tissue. With time, the implant stretches the soft tissue of the breast mound, and you will start developing a gap between the implant and the breast with shifting of the implant to the side when you lie down.
Another problem that can occur is that the implant bottoms out. This means that the vertical dimension from the nipple to the inframammary fold increases over time, and you will start losing upper pole fullness as the implant moves down. In other words, if you look at this diagram, the implant is in the right place for the first couple of years, but with time, as the soft tissue envelope stretches, the implant descends into an incorrect anatomical position.
Other problems that can occur with bigger implants are back pain; loss of nipple sensation when the nerves are stretched beyond a critical point; loss of sensation in different parts of the breast; and visible rippling as the implant soft tissue envelope diminishes. When it comes to breast augmentation from a surgical standpoint, bigger is not always better. It is well known that the bigger the implant you choose beyond the critical point where the soft tissue dynamics are affected, the more complications you are going to have down the road.
During your consultation, I will discuss these issues with you. You can still choose an implant bigger than your anatomy allows, but if that is the case, you will need to sign an additional consent form acknowledging that you understand these things can happen when you do not follow the recommendation of your surgeon.