I Want More CC's, Why Won't My Doctor Go Bigger?

Question

5'4 130lbs Bwd 13 I Am a Deflated 34b Cup. I am going with an excellent surgeon and was really upset when he told me he would only go up to 450cc's hp saline implants. I was hoping to look like a full d cup maybe dd. I don't want to spend all of my hard saved money for results that I do not want or like. My question is..Can I go up to at least 500cc's?? He just plain out refuses because he doesn't want me to have uniboob or sideboob. He is also using Natrelle 68hp do you think mentor mod+ would be better?Would luv cleavage

Gary M. Horndeski, MD · Answer

Hi,

	50 cc will NOT make a visible difference. As a general rule;  200cc roughly equals 1 cup size. So, if he is suggesting 450cc implants that will roughly take you up to a full D cup. Now, if your surgeon is placing your implants behind the muscle then he can only put in as big as your muscle will allow. If he is suggesting placing your implants on top of the muscle, then he can fit a larger implant. But, beware, implants behind the muscle retain their place for longer periods of time. Implants over the muscle have only your skin envelope to hold them in place.  FYI- the larger the implant the heavier it is and the sooner it will stretch out muscle, skin and surrounding breast tissue. I hope this helps. Best wishes, Dr. H

Larry S. Nichter, MD, MS, FACS · Answer

I don't think you are going about it the right way - that is focusing on the size of the implant rather than the appearance you want. It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link. In general your plastic surgeon's job is to guide you during this difficult process.

Jeffrey J. Roth, MD, FACS · Answer

Many factors go into selection of implant size. there is an interaction between the hard tissues of the body, (chest wall), the soft tissues, (breast), and the implants themselves. I ask patients not to get hung up on a articular cc. Bring photos of results you like to your Board Certified Plastic Surgeon. Together you can make a plan for a result that meets your reasonable expectations.

Sam Jejurikar, MD · Answer

Greetings,

	Your plastic surgeon is being cautious, and with good reason. I don't know the exact dimensions of your breast, but, in a nutshell, you can only fit so much into the current skin and soft tissue envelope you have in the breast. Although it may be possible to go bigger than the size he recommends, he may be concerned that placing in implants that large may place you at an increased risk of complications in the future, or just may not look very good right now.

	The reality of being a plastic surgeon in Texas is that, often times, patients want to go bigger then I recommend. I often times will place implants larger than my recommendation, but only after having a long conversation with the patient about the potential risks of doing so. The truth of the matter is that the difference in diameter between a 465 cc and 500 cc style 68 HP is only 4 mm (there is no 450 cc); if a 465 is okay, you could probably get away with a 500 as well.

	Hope this helps - best of luck.

Paul Gill, MD · Answer

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

Sugene Kim, MD, FACS · Answer

I usually recommend implants sizes based on 1) patients' anatomy: height, weight, chest/breat width, chest height, thickness of breast tissue and 2) patients' goal. We want implants to be proportional to patients' body as well. I think that your plastic surgeon is being safe and has a good intention. With larger implants, you may have more complications in the future; you will also sag faster with larger implant. Having said that, 50cc does not make too much difference. If you do not trust your surgeon, you may want to visit with other board-certified plastic surgeon for second opinion.

Joseph M. Perlman, MD · Answer

If you're seeing a experienced board-certified plastic surgeon (not a cosmetic surgeon who does plastic surgery), he is knowledgeable about the different factors involved in choosing the right size breast implant for you. From your photographs it looks like you have a wide sternum which limits the cleavage you would have if you're implants are placed under the muscle. If he is planning to go under the muscle, then he is limited on how far he can go immediately without developing a symmastia or "uniboob". If he goes with the silicone implant placed sub mammary, the implants can be placed more immediately to develop more cleavage. As some of the other physicians have stated in their reviews, 50 mL is not much of a difference (less than 10%).
	
	I would discuss the use of silicone implants in the sub mammary position with your surgeon. He may be amenable to increasing the size and that situation.

Steven Wallach, MD · Answer

Choosing the right implant for you is really multifactorial in nature. First it is based upon your natural anatomy and the elasticity of your tissues. Second the approximate size you want. Volume doesn't always correlate to cup size. These factors are all taken into consideration during the ocnsultation. But a 50 cc difference in volume is not a lot. Choosing the dimensions of your implants really should be based upon your anatomy.

C. Bob Basu, MD, MPH, FACS · Answer

Selection of your breast implant size is dependent partly on the dimensions of your chest wall. Your chest wall width and height will aide your surgeon with your implant size.   To maintain a full yet body proportionate look, there are indeed some limitations on implant sizes.

	 I consider two factors when selecting implants for my patients:

	1.Dimensional planning

	2.Gel Implant Sizing system

	Dimensional planning &ndash; The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. Even your fitness levels and other relevant criteria are taken into consideration. It is you who will decide what you are comfortable with.

	Gel Implant Sizing system &ndash; During the preliminary breast implant consultation, you will be provided with an option to &ldquo;try on&rdquo; a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for.

	This way your preferences are known and you can then pick a range of implants that will &ldquo;fit&rdquo; just right to give a soft natural fuller look.  So try these implants in the office to pick which look you like the best.

	Best of luck

Tiffany McCormack, MD · Answer

I would only add that I think moderate plus may look better since your breasts are fairly wide apart and you mentioned that you would love to have cleavage. The high profile are more narrow. Of course, it also depends on how wide your chest is and sometimes as we go larger even the high profile is wide enough. Have a frank discussion with your surgeon about your concerns so that you understand the reason behind his choice and so that he understands what you want your outcome to be and what your expectations are. You should be able to meet in between. Good luck!

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