450cc Tear-shaped Textured Saline - Too Big?

Hello, Im 28 year old with 2 children with some slight sagging. I have a little bit of asymetry. I am a 36B'ish. I would like a full C or small D. I want that top fullness (round) upper breast appearence. I have a 12.5 Left 13 right breast base. I am afraid to look too big! My doctor has recommended a tear shape 450cc textured saline implant. Is this going to make me look too big for my desired full C or very small D?

Doctor Answers 10

Implant Selection Process

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In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  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.
Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 95 reviews

Size is not the issue; you should NOT use textured, saline, or teardrop shape implants!

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Though size is something plastic surgeons and patients alike discuss constantly ("Too small" is the most common reason for re-operation), phrases like "natural teardrop shape", "upper pole fullness", and "proportionate, but not too big" are frequently used, but mean different things for each individual. The same goes for cup sizes, which are extremely variable among bra manufacturers. Sizing is one of the most commonly-answered questions here on RealSelf, so read numerous answers (or my Comprehensive Guide to Breast Augmentation in the Articles section on my About page), try on implants in your surgeon's office, and bring photos of your goal "look" so your chosen surgeon has as much information about your wishes as possible. Then choose the ABPS-certified plastic surgeon with experience to make the right choices to best achieve your goals.

Herein lies my concern, however. I think your doctor's recommendations are all wrong (except possibly size)! BTW, I think 450cc is probably just fine for you--by my "estimation rule of about 250cc per cup size," 450cc should add about 1 4/5 cup sizes to whatever breast volume you presently have.

Teardrop-shaped implants must be textured in order to "adhere" to your tissues to prevent improper orientation (upside-down implants would look silly, even though there WOULD be some really unusual "upper pole fullness"). This texture also prevents implants from dropping into position or any sort of post-operative adjustment to improve symmetry or appearance, and isn't needed to reduce capsular contracture below the muscle anyway. Above the muscle in a first-time augmentation is usually an error in judgement (ductal bacteria causing biofilm and higher risk of capsular contracture, much higher visibility of rippling or implant edges, less natural "feel" and look). 

Even if "perfect" position and orientation is achieved, teardrop-shaped implants stay "teardrop-shaped" and pointing straight up when you are reclining, instead of flattening and dropping slightly to the side of the chest as natural breasts do. This can be just plain weird-looking!

Additionally, since the textured surface requires macroscopic high and low spots to achieve the texture, there are "weak spots" in the wall of the implant which eventually wear out--think of the implant shell flexing with each and every breath (15,000 - 20,000 times daily) for as long as the implants are in your body--until a tiny leak springs and the implant deflates, requiring re-operation for a new implant.

Oh, and textured teardrop implants usually cost more!

So which of those things appeal to you?

Again, there are lots of expert opionions out there, but the vast majority of experienced plastic surgeons will reccomend smooth, round implants to avoid orientation, malposition, and fixation issues (more natural movement), cohesive silicone gel to minimize rippling, leak and deflation concerns, and below the muscle to give the most natural feel and softness--not to mention the significantly-decreased risk of capsular contracture (less ductal bacteria-induced biofilm below the muscle compared to below the breast/above muscle).

Upper pole fullness is achieved with proper volume (size) and a nice brassiere! High, round, coconut Baywatch breasts are decidedly NOT natural (especially nude), but if you like that look, having appropriate breast volume (implant size) can give you all you need to combine with the right push-up bra to give you the look you want, and a natural teardrop shape when not wearing a bra.

Consider this carefully, and get another consultation or three with ABPS-certified plastic surgeons who do lots of breast augmentations (over 100 per year) until you start to see a consensus! Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Implant size varies with body shape and build

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What a certain size implant will do for you varies alot with your height, weight, and body build and shape.  Smaller women would need smaller implants to effect the same amount of change to the bra size than a larger woman.  While 450 may work well for one person, it may be too large or not large enough for another.  The best size is best determined by a visit to your plastic surgeon.  Often he or she may have a set of different size implants for you to try on.


James Tang, MD
Houston Plastic Surgeon
3.4 out of 5 stars 18 reviews

Choosing between two different sized implants

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You are asking an aesthetic question and a medical question at the same time and the answer may be different to both. Larger implants may be associated with a higher rate of complications. However most patients desire larger implants. Are you willing to tolerate a higher risk for a "better" aesthetic result. See my article: The risks of larger breast implants"

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Teardrop shaped textured surface implants

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Experience over many years has failed to show any advantages of teardrop shaped implants in the vast majority of cases and the textured surface has also been largely abandoned as offering no advantages except to try to keep a non-round implant in the correct orientation. Most plastic surgeons today use smooth surface, round implants whether saline-filled or silicone gel-filled. If the implant is round and fitted to the width of the breast (I'd average the two measurements as the width of the implant should be the same on both sides), it is also possible to know how high up on the breast the implant will fill in. Usually the height is adequate to fill in the upper scallop. The exception would be a very narrow breast with a long upper scallop. In that case a vertically oriented, oval implant might be considered. 

The volume of the implant is determined by the width of the breast which determines the width of the implant and then choosing a profile. A medium profile saline-filled or a middle profile gel-filled implant will increase the apparent cup size by about 1 1/2 cups, so from a mid B cup you could get to a full C or borderline C/D. The surgeon has to look up the rated volume on the chart of implants of the determined width in a mid-profile. Based on your measurements I would think a 450 cc implant would be too big to fit and look right but with a dimensional system it is not necessary to guess. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

450cc Tear-shaped Textured Saline - Too Big

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Sounds like a good choice but you failed to post any photos. The saying is "I wished I would have gone bigger!". applies here I think. 

450cc Tear Drop Might Not be the Best Choice for You

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For what you describe, I'd probably steer you toward a smaller medium or high profile smooth round implant.

Experts will disagree on this.

Try on the implants to get a sense of volume.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

Implant choices

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The size of your implants is really determined by several things including your body habitus the quality of your skin, the original breast volume, to name a few.  It is hard to say without a formal exam.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

450 cc breast implants are very big.

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This is an art, of course, but we only use round smooth walled breast implants, and many more silicone than saline. Fewer problems, I think.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Tear drop shaped breast implants

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I am sure that if you asked 10 different surgeons the same question you will get 10 different answers. If you want upper breast fullness I am curious why you would choose a tear drop shape as that shape will not give you that result in my opinion unless you place it upside down. Furthermore if the implant rotates you will not maintain the original shape. The round implants are symmetrical so if they rotate the breast shape does not change.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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.