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Advice on Type of Implants and Position for A to C Cup

I weigh 100-105 lbs very thin, narrow shoulders am 5'4 1/2 and am athletic. I am a 32 A and i want to be a small C or just a C I think my nipples are perfect and want my breast to be perfect too. I want the them to look and feel as natural as possible. My skin seems to be very durable and stetchable. I have two children and just a few stretch marks as a result. any advice on this on type and position as well as size would be very helpful. thank you very kindly.

Doctor Answers (18)

Breast implant size/type?

+1

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.


San Diego Plastic Surgeon
5.0 out of 5 stars 719 reviews

Silicone implants placed under the muscle tend to look the most natural.

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Silicone implants placed under the muscle tend to look the most natural.

Size is a complex decision that is not only based upon your height, weight and current cup/bra size but ALSO on also on your breast diameter, waist, shoulder, and skin envelope measurements. These can only be assessed in person during a consultation. A good place to start is using my "Find your perfect size" tool listed in the left hand column of my bodysculptor.com home page. Another good place to look is the searchable database section of the physicians' photos on implantinfo.com.

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

Placement and Silicone vs. Saline

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To achieve the most natural possible I prefer the subpectoral augmentation, or under the muscle. This provides more camouflage for the implant in case there is some rippling. Because you are so petite, I believe that this would be a good option for you. I would recommend silicone implants as they are less prone to rippling and with you minimal breast tissue; you do not have a lot of camouflage. I suggest talking with your surgeon about what he believes will work best for your body and ask to see pictures.

Joseph G. Bauer, MD
Alpharetta Plastic Surgeon
4.0 out of 5 stars 4 reviews

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Perfect implants for perfect breasts

+1

Okay, do you know the difference between a plastic surgeon and God?  A plastic surgeons tries to make the breasts perfect.  God doesn't even try.  "Perfect"  should be expunged from the plastic surgery lexicon. 

Now to answer your question:  Smooth, round gel implants under the muscle.  Size should be determined by the diameter and the tightness of your breasts, not your or your plastic surgeon's imagination. 

Go online and find some before pictures that look like you and have the same height and weight.  Find some that have after pictures you like and take them to your consultation.  I find it really helpful for patients to do this.  Also, bring in some examples of what you don't like.

Also, forget about bra size.  It means nothing and if even more variable depending on make, style, etc than shoe size.

Lisa Lynn Sowder, M.D.

Lisa L. Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 41 reviews

Breast implant size suggestion

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Choosing the size of an implant is based on two factors: Your anatomy and your goals.

The most important criteria for choosing an implant is determining the width of your breast. The goal of the implant is to accentuate your natural breast and keeping the implant within your body's natural breast diameter allows for a more natural augmentation, easier camouflaging of the implant, and less issues with rippling and tissue thinning over time. Volume is based on that width by changing the projection for a given diameter range. The more volume for a given diameter, the greater the projection and the larger the augmentation. Because you have been pregnant, your skin has undergone previous expansion and will likely tolerate a larger volume if you so choose.

For women who have very little breast tissue and are quite thin (such as yourself), a submuscular placement of the implant is recommended. Even with a smaller augmentation, the implant is going to account for the majority of the volume of the your breast, and therefore I recommend a silicone gel device as it has a more natural feel than saline.

I wish you the best with your surgery!

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Choosing breast size and type is an individual decision

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It sounds like you are an ideal candidate for breast augmentation surgery though a consultation with a board certified plastic surgeon should confirm this. In choosing implant type, saline and silicone look the same but silicone may feel more natural which in a thin patient may be worth the extra cost of the implant. As far as size, this should be discussed with your plastic surgeon, however a 300 to 350 cc range round breast implant should provide enough volume to fill out a breast that has been previously stretched in pregnancy. I hope this helps.

Dr. Trussler 

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.5 out of 5 stars 11 reviews

Sizing and position of breast implants

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I disagree with other answers that the surgeon should decide the implant size and that the shape of the implant is the most important. Breast implants are pillow volume and size is not just the volume of the implant in cc's. It's closer to fitting your foot in a shoe or your body to a dress except that you can't "try on" a breast implant in spite of the attempts to do this externally. 

The positioning of the implant is based on years of experience with tissue coverage over implants. Since you can't change your skin, fat, or breast tissue, your coverage is what it is. Experience has been that getting the implant behind the pectoralis muscle at least in the upper part of the breast is optimal for maximizing tissue coverage. In a thin patient, the implant is still going to be easily felt on the side and underneath (but not necessarily seen). Therefore your best choice might be a silicone gel implant but all implants do better under the muscle. Saline-filled breast implants have other advantages but they don't feel as natural as gel under thin coverage. 

Sizing is a question of the dimensions of the implant and what effect that is going to have on the apparent size of the breast. The volume in cc's is determined by the dimensions of the breast and the available implants rather than the other way around. The width of the implant should be determined by the width of your breast and if it's a round implant (perfectly fine for nearly all breast shapes) then that also determines how tall it is. The third dimension of volume is the forward projection and implants come in at least three forward volumes. If you want to increase your apparent breast size by about two cup sizes (from a mid-A to a mid-C) then you will need a high profile implant (Allergan in saline and Mentor or Allergan in gel) that matches the width of your breast minus the skin and fat layer. You and/or the surgeon can then look up the cc's on the chart for that implant. There are implants that will fit and look right and increase size by less than two cup sizes but none that can get to more than two cup sizes in one operation. 

Scott L. Replogle, MD
Denver Plastic Surgeon
4.0 out of 5 stars 1 review

Type, position, and size of breast implants

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First and foremost, you should have the opportunity to select the breast implant that will give you the look you want. Although implant volume (cc’s) is important, the shape of the implant is just as important.

I prefer that the patient starts the process by first selecting the type, or profile of the implant. Then, after the shape of the implant is determined, you are better able to select the size of the implant that will give you the look you want.

Other factors your plastic surgeon will use to help you determine whether you want a high profile or moderate profile implant include the following breast dimensions:

  • chest width
  • breast inframammary fold
  • second intercostal space

The skin, breast tissue, and fat surrounding the implant is your soft tissue coverage. The thinner your skin, and the less fat you have in general, the greater the chance for the implant wrinkles to show through the soft tissue cover.

The technique of placing an implant 'below the muscle,' is actually a partial insertion under muscle (pectoralis major) of the top part of the implant. Over the years I have modified that technique so that the implant is covered by muscle at the top AND lower lateral half of the implant. This requires a little more dissection and time, but I have found it to reduce rippling.

Placing the implants under the muscle provides the most natural and long term result. Additionally, it is usually easier to obtain a mammogram. For additional information, see my web reference link to read my recent blog post about what causes breast implant wrinkling and how to reduce the risk. There's a video there illustrating exactly how I insert the implant.

Moderate Profile vs High Profile Implants
I've inlcuded my video, Breast implant selection: Should you choose moderate or high profile implants here for a more detailed explanation, but in short:

  • The moderate profile implant will occupy a larger diameter of your chest wall, it is wider and taller. It will not project outward so much, as it is distrubuted in a flatter, wider fashion. This implant is often chosen by patients who want fullness to the side of the breasts. In the video noted here, this profile is that implant to your right.
  • The high profile implant will occupy a smaller diameter on your chest wall as it is narrower but it also stands out more from the chest wall. This implant is often chosen by women who are slender and want more projection outward, instead of fullness on the side of the breast. In the video here, this profile is the implant to your left.

Your plastic surgeon should have various samples of implants so that you can try them on to get a better idea of how high profile vs moderate profile will look on you. Implant size and profile are not something you want to try to guess!

Ricardo L. Rodriguez, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 40 reviews

Breast Augmentation Advice

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Breast implant size depends on  the natural width of your breasts.  Implant volumes are based on their width. Since your are thin and athletic the placement with a dual plane technique (partially beneath muscle and breasts) to avoid visibility of the implant edges.  Whether you get saline or silicone implants is a personal choice. Silicone implants do have softer "natural" feel.  Finally, if you have some stretch marks on your breasts those will become more noticeable because your breast will be larger.  Hope this is helpful.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Choosing breast implant size and position

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In my opinion, under the muscle silicone implants give the most natural look and feel.  After a complete examination in consultation with your plastic surgeon, the range of implant sizes can be discussed.  Size depends on your skin quality, your anatomy and what you are looking to achieve.  Good luck with your surgery.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 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.