Should I go with 600 or 700cc? (Photo)

Without examing you, it is difficult to comment on what would be best based on your photos alone. In general, some degree of drooping, or ptosis ,can be corrected by adding enough volume . If the drooping is too great, a lift will be necessary. If a patient feels that their breasts are heavy and dependent, placing large implants can exacerbate the problem. In my practice, I frequently see  patients that have had overly large implants placed to aviod a lift, and request conversion to  smaller implants with a lift. 

hello thank you for your question and provided information as well.. based in your question and the picture you showed you are a good candidate for breast lift with implant in your case for best result you can apply for position sub glandular  , its recommended if you get a consultation in person with a plastic surgeon to determinate how many cc do you need to the better results.

600
cc or 700 cc implants weigh over 1 lb each. 
Your breasts are already descending and this will make your situation
worse.  Even 490 cc implants are too
large.  You would benefit from a lift with
fat transfer and I recommend 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 and the ability to breast
feed are maintained.  At the same time or
later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Hello and thank you for your question.  600-700cc is a large implant and you already have large breasts with some ptosis.  I would recommend a smaller implant with a lift for a more natural appearing and safer result.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.  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. 
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look. 
Remember "love the look...not the cup."
Based upon your photos alone, I would guess that 600-700 cc is very large for your frame (actually this would be large on any frame). It is important to remember that over sized implants are accompanied by a host of problems not to mention the added weight. The benefits of a subglandular ("overs") approach in a patient who needs a lift is a better match for positioning (i.e. avoiding the appearance of a high riding implant beneath a sagging breast- which would be the case in a submuscular or "under" approach). If you need a lift, then you will likely be dissatisfied with anything less. I would encourage a lift with a much more conservative implant choice.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Hard to just answer with photos and your height/weight (and not actual breast measurements). Best option is to choose a board certified plastic surgeon who actually takes the time to measure you and examine your breast pocket to determine the optimal implant size for you. Sizers will only give you a rough estimate. The goal of breast augmentation is to optimally fill your breast pocket, not to overstuff or understuff it. At my practice, we utilize a series of 5 breast measurements that help me determine the ideal implant size, which in turn helps me deliver a 24 hour recovery. Do your research and choose a surgeon who takes the time to sit down with you and discuss your goals/expectations to determine the best size for you. Good luck!!

Hi xrayz,

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.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

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

It really depends on the look you are going for.  A large implant over the muscle may look top heavy with low positioned nipple.  I would recommend the first option with more than likely a much smaller implant. 

Hi and thank you for the question. My first suggestion would be not to use high profile implants. I don't know your base width of your breasts, but that implant will be around 13cm wide which would probably bit a bit narrow for you. The same size or larger moderate style implant will be wider and also taller. This will give you a better distribution of volume in the upper pole where you would benefit from it the most. Since you have a good amount of breast tissue to start with you are a good candidate for implants above the muscle. That being said, you would still probably get a more natural upper pole with implants below the muscle. Best of luck to you.
Dr West

Thank you for the question.  I would not advise that size of implant above the muscle without a lift. Like the other surgeon said, implants and lifts are NOT interchangeable. A very large implant just makes for a very large breast. It will not lift the breast like a breast lift will.  Your pic shows some degree of sagging of the breast. This will NOT be fixed with an implant alone. I would recommend with a smaller size implant under the muscle with a lift. Best of luck to you