Wanting a full result, would 415cc, HP, be good size implants for me, or shall I go with 450cc? (Photos)

Dear Newme1806,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing. Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look."
With regards to your specific question, I would not struggle over small variations in size. A 50 ml differential is slightly more than a shot glass. This is unlikely to make or break a result.
Communication is key as you and your surgeon create your custom surgical plan.
As always, discuss your concerns with a board certified plastic surgeon.

Helo, thanks for asking, I think for your frame and for help you with the nipples, not doing a breast lift you will need 450 cc

I'd suggest 3D breast implant imaging so you can view both options. The technology allows you to control for both implant volume and profile.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

The implant size will not determine your outcome. Your breasts are too low on the chest wall. Large implants such as 400-450 cc will make you look heavy. You need a breast lift. Most women do not like breasts lifts because of the vertical scars associated with the traditional techniques. For that reason, an alternative was developed called 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 (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

It's difficult to recommend one implant over the other without examining you and discussing your goals. You do appear to be a good candidate for breast augmentation. You do have some asymmetry which will still be present after augmentation if not addressed during surgery. I encourage you to visit with your surgeon to discuss your concerns. Many have sample implants you can "try on" to give you an idea of how you may look after surgery.

This volume should increase you by 3 cups. If possible, go back to your surgeon and ask to try on all sizes so you can actually see what you make look like.

Breast augmentation results are based on three different variables. Each of these variables he’s probably equally as important.
The first variable is the patient’s candidacy for the procedure in the first place. Patient candidacy varies substantially, and this has a big impact on why some people are happy with their outcomes, and some people are not. Variables that affect candidacy include things like breast position on the chest wall, breast divergence , breast diameter, Breast ptosis and many other variables.
Implant choice is very important and this is the best done together with your provider. Each plastic surgeon will have their own way of determining implants. Some providers ask patients to choose implant size, stepping out of the decision making. This is perhaps slightly safer for the surgeon since they can’t be held accountable for the choice of implants.
My preferred method has always been for me to make the decision on the implants and I do that during the surgery.I review my patient desired outcome by reviewing lots and lots of before and after pictures. Once I have a clear understanding of what my patient is hoping to achieve, I bring those pictures with me to the operating room. During surgery I use temporary sizers to determine what shape, size and type of implant to be used. The decision regarding saline or silicone is always made in advance. The decision usually made by first determined the breast implant pocket diameter, and choose profile based on how large of an augmentation, the patient is hoping to achieve. Low profile implants generally look more natural while high profile implants create a surgical look that is not natural. Likewise, larger implants look more surgical than more modest size implants. if a patient breast is 90% implant then their breast will look like implants.
Likewise, undesirable, side affects complications, and the need for revision surgery goes up with the use of excessively large implants. The choice of projection is a direct correlation to the breast diameter, and the volume of the patient needs to obtain the results. I generally steered towards low profile unless the patient wants more aggressive augmentation in which case high profiles are necessary to get the volume within a set breast pocket diameter.
I usually have a large selection of implants to choose from in the operating room to accommodate the size, determined by the use of temporary sizers.
An ideal consult should leave patients knowing their candidacy for the procedure, and a feeling that both the patient and provider have a very clear idea of what the results will look like.
The following are some general guidelines for provider selection.
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures.
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs.
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures.
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD