I’m getting a prophylactic mastectomy with implant reconstruction. I’m 5’8 and 168 lbs and wear a 36B. The doctor recommends direct implant recon and could put in a 350cc implant, worse case 300cc. He said putting in an expander might not be an option. Why do some patients not have an option to have expanders? Will a 350cc implant look really small on a woman my size? I’m worried that I won’t be happy if my breasts look too small after surgery and would like the look of at least a C cup.
How Big is 300 or 350cc?
Doctor Answers (10)
Augmentation after prophylactic mastectomy
I am sure that you have a lot to think about if you have decided to undergo prophylactic mastectomy.I would encourage you to focus upon the reason for the surgery and its potential longterm benefits in reducing the risk of breast cancer. That said, the cosmetic result is important. A 300 cc implant will produce no more than a B cup given that the underyling breast tissue will be removed. Exactly how much volume it will produce is dependent upon implant placement, your chest musculature, the thickness of the skin draping over the implant and other factors. Discuss your expectations in detail with your plastic surgeon prior to the procedure. I generally do not favor tissue expansion because it will require supplemental surgery to replace the expander with a permanent implant or leave you with an implant with a port (which some women can feel under the skin and find objectionable). Piggy-backing two implants also has its own problems. It would be best if you could achieve the desired result in a one stage procedure. Wishing you the best of outcomes!
Breast augmentation & proper implant
It is not clear to me, why your plastic surgeon has told you that staging reconsryction by putting expander and then replacing it with a permanent implant is not an option. 300 cc implant is approximately two cups ( B cup). If you are already B cup and want to have a size larger you should consider 400 cc implants. If these impalnts put your breast flaps under undue tension, the only logical option would be to put tissure expanders to prepare enough space to accomodate appropriate size implants.
Prophylactic mastectomy and implant sizing
There is no way that I or anyone else can provide you with accurate recommendations regarding implant size for your prophylactic mastectomy without first examining you. Photos can offer some information but not as regards implant size.
There also is no valid reason that I know of that would preclude your ability to have tissue expanders if so warranted. If you want to be somewhat larger than you are now, this would be a potential approach.
You should seek out 1 or more additional consultations with board certified plastic surgeons and then decide what you would like to do and with whom.
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How to pick breast implants.
1) This is the most common type of question on RealSelf.
2) It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.
3) Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.
4) Then your surgeon has to tell you if your chosen look is realistic for your anatomy. The most common mistake is to go too big.
5) I recommend that the surgeon NOT make a final implant choice in advance, because this is just an educated guess.
6) The surgeon should have a large inventory of different size and shape implants available in the operating room.
7) Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.
8) Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating room inventory, and put in your breasts to complete the operation.
Breast implant size
300cc is equivalent to 10 ounces and 350 is about the same as a 12 ounce can of coke. Your Doctor can place different size implants under a sports bra to give you a better idea of what you might look like
Breast size after implant reconstruction
Because tissue is being removed and you are counting on the implant, and only the implant to give you volume, I would say that you would probably be no bigger than you are now with that size implant. It is possible that that is the largest implant your chest wall can accomodate at the present time. An expander can be used to stretch the skin and muscle over time in order to allow a larger implant to be placed during a second surgery. You might want to ask yoru plastic surgeon if you are a candidate for an expender in order to get you closer to the C cup you desire.
Without seeing you it is hard to predict actual cup size as a 300cc implant will give a different cup size on about every patient. Any patient that could have an implant put in could also have an expander put in. I can not think of any reason that you couldn't.
The main question is the mount of the breast tissue to be removed.
The use of the expander is to stretch the pectoralis muscle . Your surgeon may have decided to use biological tissue to help to cover the implant and avoid the expansion(Alloderm). The final size of your breast will depend on the amount of tissue removed during the prophylactic mastectomy.Your surgeon can give better answer regarding the size.
Breast implant size v cup size
It is difficult to predict what cup size a particular implant size will translate to after surgery. It depend on many factors, including the amount of breast tissue the patient starts with and the overall body frame of the patient. It is hard to say whether a 350cc implant will look too small. If your desire is to bigger than your current breast size, then you may want to go with a larger implant. Make your wishes clearly known to your surgeon so that together you two can decide which size is best for you.
Breast implant size/cup size?
The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size. This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone and low/moderate/high profile), bra manufacturer variance in cup sizes, the degree of filling of the cup with breast tissue, and the subjective differences in patients perceptions of cup size.
Much of the final “look” achieved after breast augmentation surgery depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant.
3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants. Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants. On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may make a significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
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.