When you meet with well experienced board-certified plastic surgeons, you should delineate your goals clearly. For example you may want the nipple-areola to sit higher on the breast mounds- this may require breast lifting surgery.
In regards to breast size, 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 (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.
If surgery is decided upon, it will be 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 press 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 implants and a lift
Looking at your photo, it seems that you may also need a breast lift at the same time of your breast implant insertion. The sizes you list (400-500cc) are fairly large and may get you to the cup size you want however these implants may over time cause your nipple position to drop. This is difficult to determine without examining you in person, but you may want to consult with one or more board certified plastic surgeons in order to see what the best approach is for your particular anatomy.
500CC Implant May Be Too Large for Your Frame. You May Benefit From a Breast Lift!
Based on your
pictures, it appears that you have significant breast sag in the presence of
moderate breast volume. Without the ability to perform a physical exam, it’s
very difficult to make an accurate assessment of your situation.
It would appear that
correction of your problem will require a breast lift. This breast lift will
result in your breasts appearing larger than they did when they were saggy. For
this reason alone, a 500CC implant might be too large for your body.
It’s important to
understand that correction of this type of complex problem will require that
your surgeon be able to make decisions in the operating room. It’s important
that you discuss your aesthetic goals with your surgeon and it’s also important
that you realize that decisions will need to be made in the operating room that
will optimize your result.
How to choose the right breast implant
One of the more difficult decisions in breast surgery is the type of implant and the need for additional surgery to lift the breast. Size (cc) is one consideration, but equally important is the dimensions of the implant. That is the width and height of the implant. This is also when the implant profile becomes a factor. One may choose low or high profile and various in between.
In your desires to be full but not to big, there are many factors to consider. Meeting with an experienced plastic surgeon will help to review your choices. In breast that may need a lift, there are many potential treatment plan. In an ideal world, everything would be done in one operation. But breast surgery is unpredicatable at times, even in the best and most experienced surgeon. Ultimately it is your happiness that is the most important element/ Placing an implant on top of the muscle will allow the implant to drop into the breast tissue. This may be sufficient to achieve a desireable result. But with time it may stretch the skin with the implants descent. Think rock in a sock.
Submuscular implants may stay higher on the chest with the breast hanging below. This results in two mounds aka double bubble. Sometimes the surgery may be staged. This would involve placing the implant and reviewing the results for a few months. Then depending on the patients desire, a lift can be done at a later date. This will get you the most precise results since the implants will drop and settle. The lift can be planned much more precisely. Some would do the surgery in reverse. Lift then implant at a later date. This does result in a longer time to full recovery and some additional costs. Many patients do not like this game plan and prefer both at one time. This is done with the potential for excellent results but some of the worst problems have also developed by doing both at one time. Some patients look surprisingly good after just the augmentation and /or the patient are happy with the implants alone.
What ever decision you make. This really is one of the tougher aspects of breast surgery/ Which is to make something bigger/implant and smaller/lift with removal of skin.
Breast implants and cup sizes.
1) When in doubt, always go smaller. Very large breast implants stretch the tissues and age badly. I almost never use 500 cc implants for breast augmentation.
2) Do not assume the difference in your breasts is 50 cc's. Your surgeon should place disposable implant SIZERS in your breasts during surgery to see which implants give you the best size and symmetry. Your surgeon should also have a large inventory of implants in the operating room so the final selection can be made during surgery without guess work.
3) The implants should go over the muscle. My guess is that you don't need a lift.
4) You may find the link below useful.
You definitely need a lift
From your photos, your breasts are droopy and need lifting to get a good shape. You also have a good bit of size now and implants you describe will make you huge and also are very risky if they are done at the same time as a lift.
If you just have implants with no lift, you will look large and matronly and the nipples will point down even worse than they do now. Implants won't lift you, only a lift can do that.
From your photo it appears that you will likely need a full lift. Placing those large implants and a full lift will be a difficult surgery with high risks. Also, you have plenty of breast tissue and adding another 500 cc to that will result in very large breasts.
You definitely require a mastopexy which will tighten the skin and adding a smaller implant will give you the upper pole fullness that is desired most often.
Are 450cc and 500cc Implants Too Big for D
Thank you for your question. An examination will best determine the best size implant. You may to consider a breast lift with implants for best results. Consult with a Board Certified Plastic Surgeon.
You need to try on sizers to see if you like a particular volume. You do not look like a D cup. The sizes you mention look like they will fit you well. You just need to see which you like best by trying on the sizers.
Implant Selection Process
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.