36B to D - What Size? Saline or Silicone?

to refill breasts and go from 36b to d, would you say a saline or silicone and size? I have had two children and plan to have a full tt with flank lipo at the same time. I will lose a little more weight prior to surgery, I am 5'4 will be around 138-140 lbs. I have a curvy bottom and hips, so I want to fill out the top half to be a bit more proportionate. I would hope to forgo a lift until an older age as I don't think my sag is too bad. The implants will be under the muscle.

Doctor Answers (9)

Breast Enhancement Surgery

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You have good soft tissue coverage so the implant will be well hidden, I think you could pick any type of implant and be happy


New York Plastic Surgeon
5.0 out of 5 stars 37 reviews

Implant Selection Process

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In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 36 reviews

Breast implant sizing

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 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" 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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 726 reviews

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Choosing implants size for breast augmentation

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I think both saline and silicone gel implants are good options to discuss with your plastic surgeon. It appears you have adequate breast tissue thickness to not have to worry about rippling or visibility of the implant which can be a reason to select silicone gel over saline.  I personally prefer silicone gel implants, and I think that silicone gel is the most natural feeling breast implant, but you should be able to have a good result either way.  In general, there are about 200 cc per cup size, so if you want to go up by 2 cup sizes that is probably around 400 ccs.  If you select a silicone gel implant (which often look smaller than saline), you may be somewhat bigger than that.  Tissue measurements are important and trying on implants with your plastic surgeon can focus this a bit so you have a pretty good idea before surgery what you can expect.  I hope this helps!

Sincerely,

James F. Boynton, M.D., F.A.C.S.

James F. Boynton, MD
Houston Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast implant choice and size

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Saline and Silicone Gel implants are both good options available to you.   After your plastic surgeon has evaluated your anatomy, he/she may make some recommendations to guide you.   In terms of size selection, I consider two factors when selecting implants for my patients:

1. Dimensional planning

2. Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. Even your fitness levels and other relevant criteria are taken into consideration. It is you who will decide what you are comfortable with.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for.

This way your preferences are known and we can then pick a range of implants that will “fit” just right to give a soft natural fuller look.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 117 reviews

36B to D - What Size? Saline or Silicone?

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You and your surgeon need to discuss the pros and cons of both saline and silicone gel.  You can also visit Mentor and Allergans website for valuable information.  It is a personal choice for the implant type.  As far as size, you should try on implant sizers or do the "rice" test so you can get a good idea for volume prior to surgery.  Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 85 reviews

Breast implant choice

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Since you are considering implant placement under the chest muscle, saline may be an appropriate choice. However, this alone is not a substitute for an examination by a plastic surgeon who can help you make the decision.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 18 reviews

PHOTOS: The perfect breast mplant size

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There is no secret formula and this cannot be done online. You will likely need a high profile silicone implant to achieve your goals; Size?probably no less than 350cc

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Implant choices

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The choice of the right size impalnt is something to discuss in person after a physical exam and a discussion of your needs.  I could not predict just from photos.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 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.