Plus Size Breast Augmentation: Options, Safety, and Results

Women with larger body frames often require a plus size breast augmentation so that size and shape are more flattering for their proportions. Dr. Nick Masri is double board certified and also specializes specifically in these surgeries for high bmi patients.

Many women with higher bmi who go through with traditional breast augmentation may not find the results to be quite what they’re expecting. Larger implants, precise techniques, and specialized attention after the surgery are all factors that allow plus size patients to get the best results with their breast augmentation.

What Is Plus Size Breast Augmentation?

Plus size breast augmentation is a cosmetic procedure tailored for women with larger body frames and often implants over 500cc are used. It involves customizing implant size, placement, and further surgical planning.

Key Differences between Regular and Plus Size Breast Augmentation

• Implant size: Typically 500cc or larger
• Body frame: Designed for broader shoulders and larger torsos
• Proportion focus: Balances breast size with your overall figure
• Surgical planning: Requires specialized techniques for larger anatomy

Your plastic surgeon evaluates your chest width, shoulder breadth, and existing breast tissue. This assessment helps determine the appropriate implant size that complements your body type.

Other Ways Plus Size Breast Augmentation Differs from Standard Breast Augmentation

Here are some surgical technique differences:

• A dual-plane technique is frequently used to support bigger implants and give them a natural slope, and subglandular placement is used when there’s enough tissue coverage.
• To stabilize the implant pocket and stop it from bottoming out, the surgeon may, in some cases, add internal stitches, a mesh or an acellular dermal matrix.
• Lastly, recovery is usually a 3 to 6 months affair, where patients wear a support bra, avoid heavy lifting and have regular check-ups to see how the implant is settling and perform specialized strapping and massage as instructed by your surgeon.

Trends and Body Proportion Considerations

The goal with modern breast augmentation is to achieve proportional results rather than simply maximizing size. Your body’s natural proportions can help guide implant selection and placement decisions.

Key Proportion Factors:

• Chest wall width
• Shoulder-to-hip ratio
• Existing breast tissue
• Torso length

Finally, overtime, plus size patients may experience changes in breast appearance with body weight variations over time. This may be due to aging, weight gain/loss, stresses imposed by the implant, or degrees of capsular contracture that may occur over time.

Silicon vs Saline Implants for Larger Frames

Silicone implants are more commonly used when it comes to plus size breast augmentation.

Silicone implants are basically a dream for those with larger frames, giving them a completely natural look and feel, reduced rippling and a better projection to make sure the results are perfectly proportionate on bigger chests.

However, silicone implants do require regular MRI scans every three years to check for silent ruptures.

Coming with a higher price tag at the outset compared to saline implants, silicone implants come in all different shapes and sizes.

The maximum is 800cc. However, custom implants may be ordered at much greater expense.

For those requiring more volume we recommend over filling saline implants that may be overfilled to 20% of their manufactured volume. Again, plus size patients tend to go for these.

Finally, because the cuts need to be a bit bigger to accommodate the pre-filled nature of silicone implants, recovery may take a bit longer for people, and your surgeon will have to figure out the best place to make the incision.

Saline implants, the other option for plus size breast augmentation, give the possibility of adjustability and a safer profile. When getting breast augmentation with saline implants, the surgeon fills the implant with a clean saltwater solution during surgery. This means they can be adjusted in size, require smaller cuts and are basically impossible to miss if there’s a leak, as they often will deflate slowly which often goes unnoticed over time.

Compared to silicone implants, saline implants are relatively inexpensive and are a popular choice for plus-sized women who have sufficient breast tissue, which helps hide the firmer feel they can have.

Coming in sizes from 125cc to 850cc, these implants can be fine-tuned by the surgeon to anything from 10 to 25cc. They can be over inflated or adjusted to achieve better symmetry. The weight of the implant moves exactly like silicone implants, but produces a slightly different look.

When figuring out the right size for plus-size patients, the surgeon will measure the size of your existing breasts, chest circumference and what you’re aiming for, all of which are determined by your body type.

Choosing Implant Sizes for Plus Size Patients

As mentioned selecting the right implant size for plus size patients requires careful consideration of existing breast tissue, chest width, and desired proportions. The size of your frame plays a crucial role in determining how implants will project and distribute.

Key sizing factors include:

Body Factor	Implant Consideration
Wide chest	Larger base width needed
Existing breast tissue	Can accommodate bigger sizes
Shoulder width	Affects proportional balance
Height	Influences overall appearance (in terms of desired projection and amount of visible cleavage exposure)

Most plus size patients choose implants between 400cc to 700cc. Extra large breast augmentation may require sizes up to 800cc or more for dramatic results.

Dr. Nick Masri uses intraoperative breast sizers to confirm preoperative measurements

Volume distribution differs on plus size bodies. You may need a wider base diameter rather than just increased projection to achieve balanced results.

Consider your lifestyle and physical activities when selecting size. Larger implants add significant weight that affects posture and exercise comfort over time.

Candidacy and Consultation Process

Assessing Skin Elasticity and Breast Tissue

A board-certified plastic surgeon will thoroughly examine your breast tissue quality during consultation. They check skin elasticity by gently stretching the skin to see how well it bounces back.

Good skin elasticity helps support larger implants without sagging. Poor elasticity may limit implant size options or require additional procedures.

Your surgeon measures breast width and existing tissue thickness. These measurements help determine the maximum implant size your frame can support safely.

Stretch marks and previous weight changes affect tissue quality. The surgeon notes these factors when planning your procedure.

Nipple position and breast shape also influence surgical approach. Most patients need a breast lift along with augmentation for optimal results.

Physical and Lifestyle Requirements

Your overall health status affects surgical candidacy more than your weight alone. Most plastic surgeons require stable weight for at least six months before surgery.

Research by Frey et al. in Plastic and Reconstructive Surgery Global Open (2017, PMC5340487) found that patients with higher body mass index (BMI > 30) have an increased likelihood of wound complications and delayed healing in implant-based breast procedures, emphasizing the importance of pre-operative health optimization (Frey et al., 2017).

So a BMI above 35 may increase surgical risks. However, many surgeons like Dr. Nick Masri safely perform augmentation onplus size patients with proper screening.

Key health requirements include:

• Controlled blood pressure
• No active infections
• Stable diabetes management
• Non-smoking status

You must stop smoking at least four weeks before surgery. Smoking reduces blood flow and increases complications to the breast tissue.

Your surgeon reviews all medications and supplements. Some blood thinners need to be stopped before surgery.

Regular exercise and healthy eating habits improve recovery outcomes. These lifestyle factors matter more than your starting weight.

Setting Realistic Expectations

Natural-looking breast enhancement requires frame-appropriate implants to match the body proportions, with some doctors using either 3D imaging or sizing tools to work out what’s best for their patient.

You’ll have the opportunity to talk openly with your surgeon about the type of lifestyle you lead, which types of clothes you wear and, if it’s necessary, different implants can be chosen, as would different placement techniques depending on whether you’re more of a couch potato or an adrenaline junkie.

Surgical Procedure and Techniques

Steps in Plus Size Breast Implant Surgery

Step 1: Anesthesia: Your surgeon administers medications to ensure comfort throughout the surgery. General anesthesia is most commonly used for plus size breast augmentation.

Step 2: Incision Creation: The surgeon makes precise incisions in predetermined locations. Plus size patients often benefit from inframammary fold incisions due to better access and control.

Step 3: Implant Placement: Your surgeon creates a pocket for the implant either under the chest muscle or above it. Plus size patients frequently require submuscular placement for better support and natural appearance.

Step 4: Closure: The surgeon closes incisions with layered sutures in the breast tissue and surgical adhesive or sutures for the skin.

Choice of Incision Sites and Placement

Plus size patients have different incision options that must be carefully selected based on anatomy and desired outcomes. The choice affects scarring, recovery, and final results.

Inframammary Fold Incision: This incision runs along the natural crease under your breast. It provides excellent access for larger implants commonly needed in plus size augmentation.

Periareolar Incision: The incision circles the areola edge. This option works well when you have adequate areola size but may be limited for very large implants.

Axillary Incision: Made in the armpit area, this approach leaves no scars on the breast. However, it offers less precise control for plus size procedures.

Implant Placement Options

• Submuscular: Under the chest muscle for better coverage
• Subglandular: Above the muscle but under breast tissue

Combining with Breast Lift Surgery

Plus size patients often benefit from combining breast augmentation with breast lift surgery. This addresses both volume and positioning concerns common in larger breasts.

Additionally, placement of the nipple areolar complex in plus size patients or those who have had significant weight loss/gain, childbirth, age etc will affect this relationship requiring a lift to assume a more youthful relationship of the breast to the nipple areolar complex.

When Combination Surgery is Recommended: You may need both procedures if you have significant breast sagging along with volume loss. The combination creates better shape and projection.

• Surgical Approach: What goes first is determined on a case by case basis.
• Recovery Considerations: Combined procedures require longer healing time. You’ll need additional support garments and follow modified activity restrictions for optimal results.

Risks of Extra Large Breast Implants

Extra large breast implants over 600cc can dramatically transform your silhouette but come with unique considerations. These larger implants affect body proportions differently and carry higher risks for complications like capsular contracture and implant rupture.

A 2023 study by Medor et al. in Aesthetic Surgery Journal Open Forum (PMC9995107) identified a direct correlation between implant volume exceeding 600 cc and elevated risks of capsular contracture and implant malposition—highlighting the importance of individualized sizing for plus-size breast augmentation patients (Medor et al., 2023).

Potential Complications and Risks

Extra large breast augmentation carries increased problems compared to smaller implants. The larger size puts more stress on your breast tissue and chest muscles.

Common risks include:

• Back and neck pain from added weight
• Shoulder indentations from bra straps
• Difficulty with physical activities
• Loss of nipple sensation
• Tissue stretching and thinning

XL breast augmentation requires specialist surgeons with experience handling larger implants. The surgery takes longer and may require different placement techniques.

Recovery time is typically longer with extra-large implants. You may experience more swelling and discomfort during the healing process.

Managing Capsular Contracture and Implant Rupture

Capsular contracture occurs when scar tissue tightens around the implant, making breasts feel firm or hard. This complication is more common with larger implants due to increased tissue stress.

Prevention strategies include:

• Following post-surgery massage instructions
• Taking prescribed antibiotics
• Avoiding smoking before and after surgery
• Performing massage and strapping techniques as instructed by your surgeon

Implant rupture risk increases with larger sizes due to the greater volume and weight. Saline implants deflate either immediately or slowly over time when ruptured, while silicone leaks may go unnoticed initially.

Regular monitoring through MRI scans helps detect silent ruptures early. It is recommended to follow the specific recommendations of the FDA and manufacturers.

Additional surgeries may be needed to address complications or replace implants over time. Factor these potential costs into your decision-making process.

Post-Operative Care and Recovery

Immediate Recovery: What to Expect

Your plastic surgeon will place surgical dressings over incision sites immediately after breast augmentation surgery. These dressings protect the wounds and reduce infection risk.

Pain and swelling are normal after surgery. Your doctor will prescribe pain medications to manage discomfort during the first few days.

Sleep Position Requirements:

• Sleep on your back for 4-6 weeks
• Use pillows to elevate your upper body
• Avoid sleeping on your side or stomach

Wearing a support bra after breast augmentation helps reduce swelling and supports healing breast tissue. You’ll need to wear this 24/7 for several weeks.

Activity Restrictions Include:

• No lifting over 5 pounds for 6 weeks
• Avoid raising arms above shoulder level
• No driving while taking prescription pain medication
• Light walking is encouraged after 48 hours

Your plastic surgeon will schedule follow-up appointments within the first week. These visits monitor your healing progress and address any concerns.

Long-Term Care for Lasting Results

Regular follow-up appointments with your surgeon remain important throughout your recovery. These visits help catch potential problems early.

Nutrition for Healing:

• Eat protein-rich foods for tissue repair
• Include vitamin C for collagen production
• Stay hydrated with plenty of water
• Avoid alcohol and smoking

Scar care begins once your surgeon approves it. Clean incision sites gently with mild soap and water. Pat dry carefully without rubbing.

Silicone sheets or gels can help minimize scar appearance. Apply these products consistently as directed by your plastic surgeon.

Long-term Monitoring:

• Annual check-ups for implant health
• MRI scans every 2-3 years for silicone implants
• Self-examinations for changes in breast shape
• Maintain stable weight to preserve results

Exercise can gradually resume after 6-8 weeks. Start with light activities and slowly increase intensity. Your surgeon will clear you for full activity.

The American Society of Plastic Surgeons (ASPS, 2024) advises routine imaging—MRI or high-resolution ultrasound—every 2–3 years to detect silent ruptures in silicone implants, reinforcing the post-operative care recommendations discussed in this article (ASPS, 2024).

Recognizing Signs of Complications

Contact your plastic surgeon immediately if you experience severe or worsening symptoms. Early intervention prevents serious complications from developing.

Infection Warning Signs:

• Fever over 101°F
• Increasing redness around incisions
• Warm skin at surgical sites
• Pus or unusual discharge
• Red streaks extending from incisions

Other Serious Symptoms:

• Severe, sudden chest pain
• Shortness of breath or difficulty breathing
• One breast becoming significantly larger than the other
• Hard lumps or unusual firmness
• Implant displacement or shifting

Changes in breast shape or size weeks after surgery may indicate complications. Document these changes with photos for your surgeon.

Plus size patients face higher risks for certain complications. Extra breast tissue can mask problems, making regular monitoring essential.

When to Seek Emergency Care:

• Severe breathing difficulties
• Chest pain with shortness of breath
• Signs of excessive leg(calf swelling) or pain/redness
• Uncontrolled bleeding from incision sites

Trust your instincts about your recovery. If something feels wrong, contact your plastic surgeon rather than waiting.