Want 180cc. Why Do Many Plastic Surgeons Push for More?

I'm a 5'0, 119 lbs, athletic build with big B/small C breasts. I'm very happy with my size, but starting to sag. Not doing a breast lift because of the scar, so going for implants to "lift"/fill the loss of volume at the top. Going with high profile silicone, but unsure about size. I want 160cc (180cc max), but most plastic surgeons I talk to are pushing 200 or even 230 cc. One ps said anything smaller wouldn't really do anything. Will going with 160cc/180c give me the "lift" but keep my size?

Doctor Answers 15

Breast implant size?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The more breast surgery I do the more I realize that there is no correlation between the size of implant 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 (saiine/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.

Breast augmentation will smaller implants can give nice result

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

This is a very simple question to answer. If you are happy with your breast size, you do not need breast implants.  Breast implants increase your breast size and over time, increase sagging; they do not lift.  So while I use small implants occassionally and and the patients look great and are happy, I am not sure that you actually need/want implants.  If you want to be slightly large, I personally have no problem using a smaller implant if that will meet your goals.  I just had a patient with 150cc implants and she looks great and is very happy.

Tracy M. Pfeifer, MD

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

180cc volume breast implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are several issues in question here and pictures of the breasts without a bra are not necessary to address them. 

The reason most plastic surgeons advise a larger volume is from experience in achieving a result that looks natural and achieves the expected contour and size results. Also, that a major complaint afterwards is more likely to be that "you didn't make me big enough". There is no basis for choosing a volume in cc's based on that number alone. It would be like choosing a size 2 dress because you like the number 2 even if you're not a size 2. 

Properly done, implants are sized by the width of the breast determining the width of the implant and for round implants this also determines the height of the implant (and knowing where it will fill to in the upper pole). The forward dimension is determined by the projection of the implant and there are basically three choices: low, medium, and high. A low profile implant, properly fitted to the width of the breast will make the cup size of the breast look about a cup size larger and will fill in the upper pole but not bulge it. For the average width breast this would probably be a volume of 250 cc's but we don't start with the cc's of volume. We start with the "fitting" dimensions and the choice of forward volume. 

The other misconception or unrealistic expectation is that an implant will lift the breast. No breast implant volume will truly lift the breast and there are breasts that are too low to be augmented with an implant without a lift. Breasts look lifted after an implant is placed if they aren't too low but it's an illusion caused by filling out the scallop of the upper pole and increasing the apparent volume of the breast below the nipple. 

Unfortunately, none of this can be judged by external implants in a bra and requires measurements of the breast and judging the degree of ptosis (droop). If you're nipple-areola is not too low then a properly positioned low profile implant of the correct width relative to your breast is the way to get an optimal result and don't worry about the exact number of cc's. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Picking Your Own Implant Size vs. Surgeon Recommendations

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear MissL:  As a surgeon, I certainly don't want to do anything that my patient does not approve of.  I can only guess about the reason(s) that  surgeons you consulted may have suggested larger implants.  Each surgeon's recommendations will be based on their knowledge and prior experience with patients.

160-180cc may give you the increase in volume that you desire, but not achieve other goals that you expressed during your consult and exam.  Also, very small volume implants are quite narrow in diameter, and may look odd beneath a breast that is naturally broader than the implant.  the diameter of the implant should be close to the diameter of your breast.

Hopefully you will find a resolution you are comfortable with.  Best wishes.

Sutton Graham II, MD
Greenville Plastic Surgeon

Want 180cc. Why Do Many Plastic Surgeons Push for More?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thanks for the series of photos but in nude would have helped to answer the lifting issue. In most cases an implant will give a visual appearance of a lift, but if the pre and post operative sternal notch to nipple distance is measured  their are the same. In the early 1980's, the average size implant was 250cc. Now in the 2010's, the average is 400cc's. Times, social mores, attitudes change. And the #1 compliant after implant surgery is "I wish I would have gone bigger!" So with that in mind if you are "hell bent" on 180 cc's than as long as you are fully aware and informed (informed consent) of the size limitations, I see no reason why any boarded PS would not do your operation. I know I would. I just did a 200 cc HP. We had a compromise between her and her husband from 150 cc's vs 250 cc's on 200 cc's. On the first post op visit she thought there were too big, remember only 4 days post and swelling. Best of luck from MIAMI 

Not likely to do the job you want

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

the other responders have all made good points so no need to repeat. beware thinking an aug will replace a lift and , for what it's worth,  i have only used an implant that small once in 22 years....and that woman had it replaced with a bigger implant a few years later!

Bruce K. Barach, MD
Schenectady Plastic Surgeon
4.6 out of 5 stars 13 reviews

You Can Determine Size

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear Miss L,
You can view some possible before and after breast implant size possibilities at Implantinfo.com
The web reference link shows patients before and after less than 200 cc implant placement.
The site has a searchable database where you can view before and after photos by size of implant, your cup size, your body weight and other characteristics.
You should be able to go through these multiple photos and possibilities and then do another discussion with your surgeons.

Keith Denkler MD

The implant size can be your decision if your expectation are realistic

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 The main function of the implants are to make the breast bigger and not to lift the breast. You should have attached pictures without bra for better evaluation. Your surgeons try to give you the best result and the size that they recommend is based on their experience. I would suggest that you look for a board certified plastic surgeon that offers 3D imaging so you can try different size implants before surgery.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Breast Augmentation Breast Lift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello Miss L,

I am in agreement with you that a small implant would be appropriate for your size because of your short stature and already full breast volume.  However, you are under the unfortunate misconception that an implant can RELIABLY  lift your breast.  Breast augmentation is not a replacement for a breast lift,  regardless of the size of the implant!

Women's perception of breast sagginess varies, and includes seeing tissue hang below the crease under your breast (the inframammary crease or fold), the position of the nipple on the breast mound, or the fullness (or lack there of) of the breast above the nipple.  Plastic surgeons have a system to categorize breast sagginess to determine the best remedy.

Breast implants can re-volumize the breast reliably, bringing fullness back to all areas, including the upper portions.  If the nipple is sitting well above the inframmamary crease, then it too can get a small lift in postion.  However, the opposite is true if your nipple was hanging below your crease prior to surgery, and it can even begin to point downward as it the implant pushes the upper part of the nipple out and down.  Ever larger implants will not remedy this problem either; in fact, it become less and less likely the larger implant can make the nipple 'rotate' up on the mound as that mound becomes bigger.

Your photos do not allow assessment of the true shape of your breasts, the position of the nipple, or the shape of the bottom of your breasts, nor have you described what it is you'd like to see changed with your breasts, so I can not comment on your personal situation.  My recommendation is to see a few very experienced breast surgeons who are all certified by the American Board of Plastic Surgery.  If they recommend a breast lift (with or without an implant) to give you the look that you were envisioning, but you don't want a lift, then you should consider not having any surgery at all.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Questions on implant size recommendation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Without photos of your breasts, it is even more difficult to make accurate recommendations. In general, even for your size, 160cc or 180cc may not give you the appearance that you would want a improper size is a major reason why women seek a second procedure early on. I would rely on the recommendation of your plastic surgeon who can use his/her judgement to make the final determination in surgery.

If you truly have drooping, then an implant alone will not effectively address your situation. Consequently, your breasts will be larger but not very normal or ideal in appearance. The way to resolve this would be for a breast lift.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 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.