Confused after receiving multiple consults & recommendations, what size and profile would you recommend for me? (photos)

Athletic, 31 yr old, 34A, 5'5, 120 lb, 12 cm b-width, LEO wants to be small D cup, but go back to weight lifting (5 days/wk for 13 yrs), insanity/plyo, etc. I don't want my implant look to change much after surgery (don't want softball look). Also still want kids & to breast feed. I've had multi consults...some say under some over (after I press that I want to weight lift again), all docs say silicone but they mention HP, Mod +, or form stable "gummy" (will it shift?). All say incision under crease.So I had my last 2 consults this week (after I posted above).The final 2 doctors I'm deciding on have 2 dif opinions. Help!Dr 1 originally (1 1/2 yrs ago) thought I might be good candidate for the form stable (shaped textured implant) but since he didn't know much about yet said to wait on surgery.  Today went back & 1st thing he stated was he didn't like the new implants (stated has ONLY used them for reconstruction) & proceeded to recommend Mod+ no larger than 280cc, under the muscle (again I only have 12 cm width).but then when I reminded him of how I want to go back to lifting weights & being very active he then said New Form Stable OVER the muscle no more than 300cc....this suprised me because one other doc said 450cc!Dr 2 - he is one of top 10 leading researchers/users of the new form stable (style 410) in the US.He also said 12 cm & states even with my workout regime he said HP, under muscle 275-400cc max but after I looked at computer images (attached) 375cc looked good to me.however I also got to see computer image of Mod+ (style 15?) & Mod+ implant seemed a bit more perky with not as long of a slope, but he still recommends the HP.i don't want torpedo boob!soooooo confused! Help!
Here is a link to my previous question with additional before photos. 

Doctor Answers (13)

Confused breast augmentation patient

+2
It is okay to get to varying opinions about a particular procedure. When you start to have multiple consults and multiple multiples with the same person you get to much information that can lead to considerable confusion. I would suggest a couple things one you might consider waiting to have a breast augmentation after you have your family. Number two you have to trust the surgeon that you feel most comfortable with and rely on his or her judgment. Good luck.

Earl Stephenson, JR, M.D., DDS, FACS


Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

So many consultation, and so much confusion

+2
Hi LexiBurke.

This is not a snarky answer, and I think likely different from any you will get from others.  I think you need a time out.  None of us posting on this site can tell you any better than a doctor who has had a hands on physical exam.  There is way more to this than measurements.  Judgement, experience, tissue conditions, ribs, spine, muscle, patient expectations, and on and on.

You have had so many consultations that you basically know all there is to know, except how to make a decision.  You know that there are many ways to do this procedure and everyone has a unique opinion.  In the end, only your satisfaction counts.  You must choose wisely, but how?

Take a time out.  Promise not to think about this for a month.  It will percolate in the background.  Choose the top 3 surgeons and no more.  Go in for another consultation with questions.  Have the doctor put actual implants in a bra for you to try on and see how you like or don't like it.

If you don't get an "a ha" moment, take a time out, and it will come to you.

I know it is tough to decide, but you may be over-analyzing this to the point that you are confused.  Time will help.

sek

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 45 reviews

Confused About Breast Implant Selection

+2
You certainly have done your homework, and considered your options. The descriptive paragraph you provided is very helpful. You have experienced firsthand that each surgeon may provide different recommendations based on practice philosophy, their individual patient experiences, and beliefs/biases regarding implant styles and types.

Implant selection can be a complicated process, and requires a complete patient examination and detailed consultation to reach that decision. Therefore, in many respects, the surgeons that have already examined you in detail are in a much better position to provide recommendations then anything someone else can tell you over the Internet.

In addition to base width, skin elasticity and breast skin envelope compliance are also important in the implant selection process. You do have a good starting shape, and so with a moderate augmentation, you should get a very nice result. I agree that a silicone gel implant would be your best option. With your continued desire to be very physically active, a subglandular implant position may be better, but this location does have a higher risk for capsular contracture. The Natrelle 410 would complement your preoperative shape very well. However, if you're going to continue to be extremely physically active, it would probably be best not to utilize this implant in a subpectoral position since there is likely increased stress placed on the shell as a result of the textured surface and its integration into the breast capsule.

I prefer subpectoral implant placement (greater tissue coverage, lower risk of capsular contracture, less rippling, improved mammography) and an inframammary approach (ability to make a longer incision, control of the inframammary fold, good exposure, reusable) because of the benefits they offer.

The simulation photograph you included certainly shows a nice result using a 375cc high-profile (style 20) round gel. You mentioned that you don't want your breasts to have a "softball look" or be "torpedo boobs". A high profile implant is more spherical in shape, and out of all the implants, is most likely to give this type of look. I believe high-profile implants also direct greater biomechanical stress on the breast anteriorly and inferiorly. In patients with less skin elasticity, this stress can lead to stretching of the inferior pole skin (over time), and additional implant descent, producing a high riding nipple-areolar complex. For these reasons, you may wish to consider a moderate profile (style 15) implant instead. This may mean that you have to settle on a slightly lower volume, but in the long run may achieve a better result.

There will be advantages and disadvantages to every decision regarding pocket location, fill material, implant style, and implant size. Ultimately you should settle with the surgeon that you believe understands your needs the best, and (the one you trust) will give you the results that you desire. I hope this was helpful. Best wishes.

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 17 reviews

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Confused

+2
Way too many moving parts here, you need to pick the doctor and tell him or her what you want in your own words, it seems you are being moved around. With your anatomy and desire to workout I would likely do 270 under the muscle

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
5.0 out of 5 stars 36 reviews

Confused about breast augmentation

+2
Your situation is not uncommon for patients who seek out multiple opinions. Part of it is probably the various philosophies, experiences, and biases of surgeons and part of it is the nature of breast implants. All implants have advantages and disadvantages to their uses. There is no single implant that gives a patient everything without some unwanted side effect or potential complication. That is why there are so many choices. The goal has to be to find a best fit procedure that produces a result that you can be satisfied with (not necessarily your ideal result) with the side effects and risk profile that you can tolerate. Rarely can you get everything for nothing. I cannot advise you on the specifics of your surgery without a full examination and a comprehensive consultation process that I perform over multiple meetings. Often it is not the specific operation that is done that is important (since there are situations where the choice of implants is relatively irrelevant and other situations when the choice is paramount) but it is the relationship and trust in a surgeon's specific philosophy that is more valuable.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 7 reviews

Not one way to do breast augmentation.

+2
The good news for you is that you have great shape to start with, so you should get a great result no matter which option is chosen. There are pros and cons to every approach to breast augmentation and the various implants. You will also have to set your own priorities. If working out with a lot of pectoral muscle activity is your priority, then yes, you may be better off with subfascial (sub glandular) implants - the trade off for this will be a statistically higher capsular contracture rate.
With regard to size, the first priority is to decide how big you want to be - remember this is for you. Use the computer imaging to help you make a decision on how you want to look. Then as long as the size is within a reasonable range for your frame, go with it. 
I find that many people agonize over what is right and wrong, there is no right and wrong, there are simply pros and cons of each approach. Balance these pros and cons according to your needs and choose a size that makes you look the way you want to look within a reasonable range.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 37 reviews

BBA

+1
There is no way to guarantee a particular bra size. Bra sizing varies greatly between bra manufacturers and a C in one bra will be a D in another. What matters more than the assigned bra size is the way the implant looks on you. The best option for your body and aesthetic goals can be determined in a thorough implant sizing session.
Implant sizing depends on several factors. One of the most important factors is your breast width. Generally, your surgeon will measure your breast width, and then provide you with a range of implant sizes appropriate for your native breast size. There are more nuances to it than just what I've described, but this approach works for most women.
I usually have my patients bring in a large bra and a tight t-shirt to do sizing. I'll then choose 3-4 implants that I feel are appropriate, and have my patients place them in the bra under the tight t-shirt. My patients can then look in the mirror and get a good sense of what they will look like with the provided implant sizes. My patients like this approach and get a great idea of how they will look.
By using this technique, your surgeon can outline a range of appropriate implant sizes that will be aesthetically pleasing, and you make the final decision.
I hope this helps. Good luck!

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 28 reviews

Breast enlargement choices

+1
Unfortunately, a patient tends to get confused visiting more than a couple of plastic surgeons. I would go with the one that is certified by the American Board of Plastic Surgery, you feel comfortable with and you like his results on his website. The implant manufacturers have further confused the issue by having numerous different forms/shapes and now having the form stable. I have used this in my practice in Europe and I can't say it is that great for it definitely feels firmer. I almost never use the crease incision for if that heals bad(in about 20% of cases) it is ALWAYS there and sensation and breast feeding is the same no matter where the incision is placed.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 24 reviews

Confused about choosing breast implants–take a time out

+1
Thank you for your question.  You have way too much information and have been confused by getting so many different opinions.  I understand why this is causingyou so much stress, that is only natural.

I honestly believe your best course of action is to stop thinking about breast augmentation and wait 6 months before considering having breast implants.

That said smooth walled, moderate profile plus silicone gel breast implants are designed to mimic the natural shape of the breast gland and are the easiest implants for your surgeon to place through an inframammary crease incision.  Most variations of this basic breast implant are designed for specific indications or to solve a problem.  Your breasts are very normal and naturally shaped thus you do not need a special type of breast implant in my opinion.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 29 reviews

Implant volume and cup size

+1
At size 34 A each 100 cc’s of implant corresponds to 1 cup size change. 300 cc implants would take you to a D. I always recommend small round textured silicone gel implants placed retro-pectoral since they look and feel more natural, are more stable, less likely to ripple or have complications needing revision. Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it. Since you are very active, I recommend the smallest implant possible, which will have less displacement with muscle contracture.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 123 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.