5’8, 200 lbs, size 36/38B. 400cc? Very active and muscular. BWD is 12.5. (Photos)

Hi mdw2018,
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, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

At
size 36 or 38, each 200 cc of implant corresponds to 1 cup size change.  400 cc implants will take you up 2 cup
sizes.  Also, 400 cc implants weigh close
to 1 lb, will descend inferiorly and laterally requiring revision.   I recommend you consider smaller implant to
achieve your desired goal.Best Wishes,Gary Horndeski, M.D.

I appreciate your questionAfter performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Implants that are wider than this can be more palpable, fall more laterally overtime and also be more palpable. After that we will then choose the implant volume based on the measurements and also looking at any asymmetries you might have. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other peoples bodies and your results will probably be different.Silicone will give you a fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured. Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak. Implants, indifferent projections. The easiest way to think about it is they called me in a low medium and high projection or profile. Most of the time I use the medium profile which gives people the best in terms of natural look as well as a little bit of projection. High profile implants are for someone that wants  A little bit more of a fuller look. Low profile implants are better for someone that really wants a minimal extremely natural augmentation. Depending upon the anatomic versus round implants there are also subtle differences  in terms of the amount of projection for each profile. During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.In order to limit pain from breast augmentation and speed the recovery process I offer patients Botox into their muscles as well as a long acting numbing medication called exparel. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr SchwartzBoard Certified Plastic Surgeon #RealSelf100Surgeon#RealSelfCORESurgeon

Your wish pictures are possible. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I do this 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

Hi MDW!  Thanks for your question.  I agree with your PS and like your plan.  Please be aware you have a slightly tuberous shape to your breasts.  Here are a few tips for you because this is perhaps
the hardest decision for a patient to make, as well as the surgeon.  Also see the video attached to my answer.  We spend up to two hours for our BA consults
to be sure there is careful communication. We do a full exam in front of a
full-length mirror taking six exact measurements.    We
put your photos on a large computer screen for imaging, and go over your
“ideal-size” photos. We then save this information to your password protected
“web account.”
     First and
foremost the implant should fit the dimensions of your breast and tissue cover.
 Balancing the implant to your
over-all body shape and tissue cover is essential.    The main thing is to
have the diameter of the implant fit the diameter of your breast "foot-print".
 Higher profile implants tend to have a smaller diameter.  Higher is really a marketing term, but often
translates into the same volume implant with a narrower base.  Saline implants actually tend to decrease in
diameter as they are inflated!  The average size chosen over our last 7,000 breast implants was
“350cc”.  BUT, 90% of our patients tell us they wish they were
bigger a year after BA.  (We will see you
every year for routine checks at no charge.) It’s like your mind incorporates
the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients
that they will experience an increase of approximately one cup size per 200 cc.
 You can try on implants in the office by
placing them into a special bra.  The implant is also flattened somewhat when under
the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for
flattening of the implant in the partial sub-muscular pocket.  Once you decide on a size you like, then add
on 25cc, because in real life the implant will be flattened slightly by your
tissues.  Multiple measurements need to
be taken to fit an implant to your exact anatomy.  Have your surgeon's
office show you the charts of the implant dimensions for the various profiles
of silicone and saline from the manufacturer.  Then you and your surgeon
can piece together the puzzle by matching your measurements, with your wishes,
versus your tissue cover and the available implants to arrive at
a surgical plan.  Keep in mind
larger implants tend to have more problems over the years.  Since silicone implants wrinkle less than
saline implants, they might be your best bet.
     You can
also approximate this at home by measuring out an equivalent amount of rice
placed into a cutoff foot of old panty-hose, and put this in your bra.  Wear this around the house for a while, and
see what you think.  Implant size must
square with assessments of tissue cover, breast diameter, and chest wall width.
 Multiple measurements of your chest wall
are taken (seven in total).  Implant size
selection has been an issue of much discussion.
    
Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.  Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape.  A photo album of patient
pictures is maintained to assist them.  These photos ultimately help in determining
where the implants will be placed, since they can be shifted inside (to provide
more cleavage), to the outside, up or superiorly, and down or inferiorly during
surgery.  In determining the final size
selection, I always place the highest priority on the preoperative measurements
and potential tissue cover.  Finally,
your verbal requests are factored into the analysis.
     We use
the quick-recovery approach, so click on the web reference link below to have
this explained and you can see the list of Quick-Recovery (Flash-Recovery or
Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery
journals.  It is a surgical procedure that
uses special instruments and techniques to minimize tissue damage and avoid
touching the ribs. It causes far less trauma to surrounding tissue than
traditional approaches, and it dramatically reduces pain and recovery time. In
published studies of BA patients, 95-percent of women interviewed after the
procedure returned to normal daily activities within 24-hours. Quick-recovery
BA is not a “gimmick.”  These specialized
techniques, which actually speed recovery and get you back to your daily
routine, kids and work, are published in our plastic surgery journals.  Because these PS journals are “peer-reviewed”
and edited, they are the gold-standard in our field as being valid science.
Therefore, these are sound techniques, not marketing hype. 
     Be sure
to see only a board certified plastic surgeon (by ABPS - The American Board of
Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic
Plastic Surgery) and or a member of ASPS (The American Society of Plastic
Surgeons).  Also, ask if the PS has an
established, high volume breast augmentation practice, performing several
hundred breast augmentations each year.  Be sure the PS has been in practice for a
while, about 20-years might be a good gauge. 
Does the PS offer all three incisions? 
Discuss the implant type (gel or saline), shaped "gummy bear"
or non-shaped, smooth or textured, implant pocket (over or under the muscle)
and the "quick-recovery approach." 
Ask to see their before and after photos if you didn’t see any on their
website.  If they are experienced, they should have several 100 breast
implant patients for you to view.  I would also recommend that your doctor
offer you the chance to talk to past patients who would be happy to discuss
their experience with you.  You need to feel comfortable, so make sure the
environment is safe as in an accredited surgery center.  Also, ask a prospective surgeon if he or she
has ever published journal articles in professional peer-reviewed journals,
which they can provide you.      
All the best, “Dr. Joe”
 
 

Hello and thank you for your question. Judging from your photographs alone, I think you would be a good candidate for a breast augmentation.  However, you may also have elements of a Tuberous Breast deformity that require some further special techniques during your surgery.   The typical components of tubular breasts
include a widened areola, constricted (shortened) lower pole i.e. area between
your nipple and inframammary fold, herniation of breast tissue through the
nipple areola complex, and a narrow breast base.  

From a general standpoint, your question
does bring up the overall process of ideal breast implant selection which
can be quite involved, as breast augmentation involves a number of different
issues.  The first step would be to clearly define your desired
breast outcome goals – this would include the size you would like to achieve,
and your ideal breast shape.  I would then select the best breast implant
for you based on:


(1)   Volume of the implant –
actual implant sizers that you try on during your consultation can help with
this.  I commonly used the Mentor volume sizing
system for this purpose.


(2)   Contents of the implant –
saline vs silicone, saline tends to be a little stiffer, rounder and can cause
rippling of the skin


(3)   Shape of the implant –
round or anatomic;  I would show you how both round and anatomic can
provide a natural shape


(4)   Position of the implant –
if it is over or under the pectoralis muscle; each location would provide a
different shape and projection.  The
advantage of going “under the muscle” is that it provides a lower risk of capsular
contracture, lower risk of skin rippling, and better visualization on future
mammograms.  Also, many patients describe
the appearance as more natural, and describe the feel as more consistent with
that natural breast.


(5)   Skin stretch of your breast
– younger patients tend to have more taught skin with more… SHOW MORE
resilience, and respond well to an implant; compared to an older breast with
more stretch marks, which would typically requiring a larger volume to fill the
breast


(6)   Degree of breast ptosis
(sagging) – a significant sag would benefit from a breast lift


(7)   Breast diameter and overall
chest circumference


(8)   Native breast tissue volume
– the amount and distribution of the natural breast tissue.


(9)   Any history of prior
surgery or trauma to the breast


The next step for
you is to seek out a board certified plastic surgeon who specializes in
aesthetic plastic surgery.  In your consultation, be sure
your surgeon addresses all your concerns and discusses the surgery details
including the position and size of the incision used (with actual photographs),
the type of breast implants available, the risks and benefits of the procedure,
recovery time, and post-operative course.  Also, be sure to see plenty of
before-and-after pictures in women who have a similar breast appearance to
yours, and preferably at different time frames (3 weeks out, 3 months out, etc)
to more accurately predict your own surgical outcome.


And lastly, I think the most important
component of the consultation is to establish a good connection with your
plastic surgeon.  It’s the connection that allows you to clearly define
your desired breast outcome goals, the first step of this whole process. If you
don’t feel you have a good connection with your plastic surgeon after your
consultation, he/she may not be the best surgeon for you.
For more information on breast augmentation, please refer to the link below.


Good luck.


Mark K Markarian, MD, MSPH


Harvard-trained Board
Certified Aesthetic Plastic Surgeon

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  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.  This entire surgery
can be performed with a small incision technique.  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.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

A 400 cc implant will increase your cup size 2 or 2.5 sizes. Discuss this with your surgeon, there may be limits to the size your surgeon can safely place for you.

The best cosmetic result in any particular breast
augmentation patient depends on a variety of factors, including: Your
individual anatomy, desired outcome, realistic expectations, a thorough
discussion with the plastic surgeon about the options, and an understanding of
the pros and cons of any particular implant choice. Proper sizing is not just
about the number of cc’s. The thickness of your tissue, breast dimensions which
include the width, height, and projection, as well as chest wall width all need
to be considered when choosing an implant. Trying on implant “sizers” of
various shapes and volumes while wearing a tight t-shirt, bra, or bathing sit
at a preoperative visit will help you and your surgeon choose the optimal
implant.
There are no manufacturers' standards for cup sizing in the bra industry. The
cups of a 32 D and a 38 D are significantly different. Cup size varies from
manufacturer to manufacturer and even within styles from any particular
manufacturer. There is also no direct correlation between an implant size or
shape and resultant cup size.
Keep in mind that following the advice from a surgeon on this or any other
website who proposes to tell you exactly what to do without examining you,
physically feeling the tissue, assessing your desired outcome, taking a full
medical history, and discussing the pros and cons of each operative procedure
would not be in your best interest. I would suggest that your plastic surgeon
be certified by the American Board of Plastic Surgery and ideally a member of
the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and
are comfortable with. You should discuss your concerns with that surgeon in
person.
Robert Singer, MD FACS
La Jolla, California
 

Looking at your pictures looks like you’re an excellent candidate for a breast augmentation. It’s important for you and your surgeon to be involved in the process and have clear communication. Education is king! Different things can be used to figure out what size is best for you such as your measurements, simulation, trying on implants, and using a reference photographs. Good luck to you.