Breast Lift and Implants on a Large-framed Woman?

Question

I am 6'2. Yes, very tall! And I am 195 lbs and look pretty good, but having 3 kids and nursing them has diminshed my breast size and shape. I used to be 36 B before kids and looked small! Now I am 38C but it doesn't look nice. So I am getting breast lift and breast implants. I'm thinking of 425cc. My dimension is 13.5. I want to look like a full C, but I know that it's tough to judge on me because of my larger skeleton (think Gaby Reece). I'm also not sure whether to go silicone or saline. Any advice? Thank you!

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

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. The same process goes for just filling in the upper part of your breast without becoming much larger.  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 link below including silicone vs saline implants:#breastimplant#breastaugmentation#breastliftwithimplants

David Stoker, MD · Answer

Silicone gel implants feel much better than saline.  They also have a smaller chance of showing ripples.  The new generation cohesive gel implants are particularly nice.  Go with silicone unless you have a strong preference for the saline.

Richard J. Bruneteau, MD · Answer

It’s
virtually impossible to make a specific recommendation without pictures or a
physical examination. Your approach to this problem appears to be reasonable
and should hopefully give you the result you’re looking for.

Because
you have a large frame, your choice of breast implants will significantly
impact your aesthetic result. In most cases it’s important to have harmony,
balance and proportion with the surrounding structures. In other words, rather
than targeting a specific size, it’s better to have a good fit.

The
choice of implant material is also important. Multiple implant materials are
available for breast augmentation. These fall into three broad categories
including silicone gel, cohesive gel and saline implants. Although each of
these implants offers advantages and disadvantages most surgeons feel that
silicone gel implants feel more natural than cohesive gel or saline implants.

It’s
also important to consult a board certified plastic surgeon with experience in
this area. This surgeon should be able to formulate a treatment plan that’s
appropriate for your problem.

Jeffrey E. Schreiber, MD, FACS · Answer

It sounds as though you have a great plan to improve your breast aesthetics. A lift is frequently required with an implant after the breasts have gone though lactation. To pick the best size, I would recommend finding some photos of breasts that you like and showing them to your plastic surgeon. Also, try on some implant samples underneath your bra to get a general idea of the look that you desire. Silicone implants are 100% FDA approved and give a very natural appearance with a natural feel over saline implants. Both are safe, and I mostly put in silicone implants. Good luck!

William Rahal, MD · Answer

You seem to have two very different concerns, namely implant size and whether to go with saline or silicone. To answer the first part of your question: It's impossible to say whether a 425cc implant would satisfy your beauty goals without getting a consultation first, and even then I would take care not to focus on cup sizes as a goal, especially for a woman with a larger skeletal frame.What's more, cup sizes are often inconsistent between different bras, even those made by the same brand. Also, keep in mind that you're not only getting an augmentation, but also a lift, which means your final result (and therefore your cup size) will also depend on the type of lift you get and the amount of skin removed. Even without the lift, the amount of cc's it takes to increase a cup size varies from one woman to another.

In my experience, these factors along with several others make trying to predict cup sizes too difficult no matter how much time we spend during the consultation. This is why I suggest not aiming for a certain cup size and instead aiming for a certain breast size and shape.
Now, for the second part of your question - when it comes to being undecided between saline vs. silicone implants, you're not alone. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you?
A term that I use with my patients for the perfect implant is the “Pony Implant”.
So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural.
Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small.
And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!"
That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours.
This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it.
Thank you for reading and best of luck on your journey!

Tom J. Pousti, MD · Answer

Thank you for the question.

	In my experience, the most common regret &ldquo;large framed women&rdquo; have after breast surgery  is that they wish they were larger ( larger breasts) and more proportionate to the remainder of their torso. Instead of selecting a breast implant size prior to surgery I would suggest that you  communicate your size goals with your surgeon.  

	In my practice I find the use of goal pictures to be very helpful.   I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" or "top heavy" 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. Placing breast implants on top of the skin ( pre-operative &ldquo;sizing&rdquo;) is not necessarily accurate either.

	 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 breast 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.   

	In regards to the choice of saline versus silicone breast implants:

	For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. 

	On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants. Other differences involve how the breast implants are filled. Saline implants are filled after they&rsquo;re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.

	 On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers&rsquo; saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.  

	I hope this helps.

	I hope this helps.

Steven Wallach, MD · Answer

There are many volumes and shapes to choose from and those are discussed during a lengthy exam and consultation. As for saline vs silicone again the same thing.

Michael C. Edwards, MD, FACS · Answer

The best counsel can be given to you after a proper consultation and examination. It sounds as though you are a good candidate for this procedure. I have patients size with breast implants in a sports bra to make sure they feel comforable with their choice. This is by no means a perfect way to show you what you will be but is the current best I believe available. You appear to have a plastic surgeon already so look at their photos, ask them the what they feel would look best on you. Your choice of  saline or silicone is a personal one. I use silicone in approximately 80-85% of my patients but this is their choice after I go over the options. I hope this helps.
Dr Edwards

Steven Yarinsky, MD, FACS · Answer

Your body frame size should not matter. You can have a breast lift and augmentation. Speak with your surgeon about an appropriate implant volume. Saline or gel implants can work. Gel are more expensive and require follow up MRI studies to rule out a silent rupture, and if you already have some of your own breast tissue to cover the implant surface, I have not found the results to be that different with saline implants. Best of Luck!

George J. Beraka, MD (retired) · Answer

How to pick breast implant sizes
1) This is the most common type of question on RealSelf.
2) It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.
3) Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.
4) Then your surgeon has to tell you if your chosen look is realistic for your anatomy. The most common mistake is to go too big.
5) I recommend that the surgeon NOT make a final implant choice in advance, because this is just an educated guess.
6) The surgeon should have a large inventory of different size and shape implants available in the operating room.
7) Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.
8) Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating roon inventory, and put in your breasts to complete the operation.

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