A Weight Off Your Chest


It goes without saying that before embarking on breast augmentation surgery, one must know all the pros and cons beforehand. This particularly rings true for those who are considering large breast implants, due to the risks involved. Dr Nerina Wilkinson reports on what to expect when opting for a larger size, and advises on a lighter implant choice that aids in preventing long-term complications. 

After 20-years as a plastic surgeon, I still find breast augmentation as one of the most satisfying procedures I perform in my practice.  It is always satisfying to see the positive transformation it makes in most of my patients.

How do you know what size to choose?

The size a patient chooses depends on the patient’s expectations.

The recent trend in breast augmentation surgery has been towards more natural looking breast implants.  And while choosing the correct implant size for a patient is not complicated, it is definitely scientifically based.  This is because the size of the implant is determined by specific mathematical calculations, which is according to the exact size of the patient’s chest wall and width of their existing breast. These implants are therefore like a designer dress – the size and shape is determined by the patient’s proportions, and should fit that specific patient perfectly.

What are the risks of a very large breast implant?

When patients request breast implants that are too large, I will always discuss the risks involved in choosing such a size. Hookes law can be used to describe the effects that an excessively large implant may have on the breast tissue.

More weight = More stretch

A breast implant weight directly impacts the breast tissue (see image 1)

Undesired effects due to implant weight are:

  • Accelerated breast ptosis, i.e. hanging of the breasts
  • Breast tissue atrophy: the existing breast tissue decreases due to pressure of the large implant
  • Implant rippling is visible due to the base of the implant being too large for the patient’s chest dimensions
  • Traction rippling due to a heavy breast implant
  • Inframammary fold breakdown due to the heavy implant weakening the fold, thus resulting in a low breast fold
  • Reduced patient comfort

What are your choices if you would require a larger breast implant?

In my practice, most patients request smaller natural breast implants. However, there are certain patients who would like to increase the size of their existing breast implants; or require more upper pole fullness due to sagging skin.

As a result, the answer to Hookes law is to use an implant that is lighter in order to prevent large implant related complications.

There are 2 options:

1) Hybrid breast augmentation

This technique involves combining a smaller breast implant that fits the patient’s chest wall dimensions with fat transfer to the upper pole of the breasts.

How it works

At the time of the breast augmentation surgery, your own body fat is harvested from the flanks or thighs; and is then injected into the breast to improve the shape.

Fat transfer results in lifting to the general structure of the breast, while camouflaging the edges of a visible implant. The goal is to give fullness to the breasts, thereby achieving a more youthful state.

Unfortunately however, not everyone is a candidate for this type of procedure. For instance, fat grafts to the breasts are not a viable option for women lacking significant sources of donor fat for liposuction (i.e. very thin), as the volume required is quite high.

In these patients I would advise choosing a “lighter” breast implant.

2) The lighter option

*There is now a new generation of breast implant available that is up to 30% lighter than conventional breast implants. By using space technology, the manufacturers have found an innovative solution to decreasing the weight of breast implants.

How it works

The technology uses microspheres that are:

  • Made from highly processed boro silicate
  • Hollow, filled with inert air to reduce weight
  • Biocompatible
  • Crush resistant
  • Widely used in medical applications and space technology

Moreover, recent studies in high volume breast augmentation surgery have shown that patients with these new lighter breast implants (compared that to patients with conventional implants) had less post-surgical pain, required less analgesic medication and shorter recovery time.

Take home message

My advice to all my patients requesting breast implant surgery is to choose an implant that will achieve beautiful, natural looking results that complements their figure, and is proportional with their frame.

And as for those patients who are seriously considering a large size, then a lightweight implant would be an option, as it can aid in preventing long term complications associated with large implants.

Disclaimer: *As implants are registered as medical devices, we are unable to mention the brand names of implants according to South African regulation. The lightweight breast implants mentioned in this article are distributed by Tasosol (PTY) Ltd, an importer and distributor of various medical and aesthetic devices www.tasosol.co.za | info@tasosol.co.za. Ask your doctor for more information on these implants. 

Written by Dr Nerina Wilkinson, MBChB (Stell), FCS Plast SA

  • Plastic and Reconstructive Surgeon in private practice based in Cape Town
  • Founder of Dr Nerina Wilkinson & Associates www.plastic-surgery.co.za
  • Board Member of The Cosmetic Surgery Institute
  • Plastic and Reconstructive Surgeon with the Health Professionals Council SA
  • Association of Plastic, Reconstructive and Aesthetic Surgeons of SA (APRASSA full member)
  • International Association of Aesthetic Plastic Surgeons (ISAPS full member)
  • Fellow of the College of Surgeons SA
  • AAMSSA (Aesthetic and Anti-aging Medicine Society of South Africa)

A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice. 

Issue 32 – December 2019 (Summer)

This article was written by Dr Nerina Wilkinson and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Dec 2019 Edition (Issue 32). 

A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skin care, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).

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