Should I get 350cc or 400cc HP? (Photo)

Question

I’m 5’3’’, 105lbs. Very petite, narrow width on chest and waist. Will put the implant under the muscle. But still can’t decide which size to go with. I want achieve a round full looking but not too fake. Should I do 350cc hp or 400cc hp?

Jose Perez-Gurri, MD, FACS · Answer

Hi, based on the non-operated photos, which I assume they're yours, I would suggest silicone gels 400cc HP would be fine. I would insert either through a periareolar or fold approach, underneath or behind the chest muscle.Always seek out the opinion of a surgeon certified by the American Board of Plastic Surgery with years of experience in cosmetic breast surgery. Furthermore request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits? 
How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.
How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications.
In our office, as in others, we use TouchMD which is a web based program in which patients have the ability to load their picture unto the program. I then evaluate them and can actually draw on the picture to show a potential patient where the incisions would be located and how the procedure is to be realized. It's all done to comply with HIPPA which is the federal law that protects the patient's medical information. Look them up.
Good luck, Dr P

Daniel Barrett, MD · Answer

Dear viaregina,Implant profile is a very important consideration. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This has several problematic consequences. The first is that the patient loses width and therefor cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants. High profile implants do have a role in symmastia repair (when I need to narrow the basewidth) but otherwise I try to avoid them.Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

Your breasts are too low on the chest wall and if you get large implants this will require the inframammary fold to be released resulting in bottoming out or double bubble.  You would benefit more from a breast lift and the technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person evaluation by a plastic surgeon to be measured and discuss your goals. After I measure and discuss goals with my patients, we then look at pictures of women with similar measurements with different size breast implants. My patients tell me that this process is very helpful in determining what size breast implant is right for them. 
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author  
RealSelf Distinguished Hall of Fame Inductee

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate for a breast augmentation.  Both 350cc and 400cc HP should be able to accomplish your goals.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   
 
 Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

John L. Burns Jr., MD · Answer

3D imaging allows you to accurately visualize what you will look like after the procedure.   Using the technology you can control for implant volume, profile, and shape.

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look. 
With regards to your specific question, I would let your BWD be your guide. As both options are within the same profile, increasing volume will increase width and projection. The increased width may create a BWD mismatch. In addition, the increased projection comes at a cost of subtlety (albeit a small cost). As long as you are respecting your BWD, the volume differential is subtle and unlikely to dramatically alter the outcome.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Jeffrey K. Scott, MD · Answer

Thank you for your question. Hopefully you have undergone various biodimentional breast and chest measurements in order to be guided thru the sizing process. Either of the sizes listed will provide you with a full and perky breast look. To put things in perspective, the difference between the 350cc HP and 400cc HP implants is minimally over 3 tablespoons in volume and only a few millimeters of implant width and projection. Best of luck with your upcoming  procedure.

Darryl J. Blinski, MD · Answer

Than split the differences use a 375 cc implant might be the easy decision. Sounds like the story of Goldilocks and the Three Bears... You are looking for the 'just right' decision.

Should I get 350cc or 400cc HP? (Photo)

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