300cc or 350cc over the muscle? (Photo)

Dear curiousbrunette,

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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Firstly, over the muscle is a bad idea as hardening of the implants. There is a philosophy that over the muscle can help with ptosis, but I do not think it really addresses the underlying ptosis. Secondly, I would not call your breasts tubular . . . tubular breasts have a specific set of criteria none of which you have. What you have is just a little bit of ptosis with an overall natural look. Thirdly, you cannot expect to look like the augmented photos that you posted, her anatomy is completely different. However, what you can expect is a nice, natural result with an appropriately sized saline implant (no long term surveillance issues with no worries compared to silicone with low subsequent cost long term overall). Of course, you may need a lift in the future, but I would not push you toward that initially and wait until you have kids or until things change as time passes. Thank you.

Tuberous breasts are characterized by a constriction of tissue around the nipples and indistinct breast fold. It doesn’t appear that you share these traits. Rather, your nipples sit a bit low on your chest, therefore a lift would be recommended as you stated. The implants are centred behind the nipples so you would not have the same cleavage as in your wish pics. Your breasts would sit further apart. Regarding the size of implants, sizers are a great way to give you a better understanding of how may look after surgery. you can try 300 and 350 to see which one you prefer.

Hello, I agree that placing the implant over the muscle will be best for achieving your goal. The difference between the two sizes that you are thinking about is about a shot glass in volume. Depending on your breast width measurments one implant may fill out your breast width more allowing you to have your breasts closer together like in the photo. When placing on top of the muscle choose an implant that does not have a high chance of wrinkling or folding. In my practice I suggest using a Mentor Mod Plus Xtra or a Mentor Mod Plus Boost when going over the muscle.

You can have a lovely result from breast augmentation, but your breast implants can never be that close together. Regardless of whether you go over or under the muscle, the result will be the same: visibility of the implants with severe wrinkling. That is why you should keep it under the muscle, where long term results are best and the risk of capsular contracture are lowest. As for a lift, an examination of breast skin quality and nipple position will determine the necessity and/or type of lift. Regardless, implants should be placed through an inframammary incision.

At size 34, each 100 cc of implant corresponds to 1 cup size change. 300 cc implants would take you to a DD. I recommend something smaller in the order of 200 cc. Also, I recommend a circumareola approach with a lift. Your breasts are widely separated and have very little cleavage. If you do not do a lift then the implants will have to be centered underneath the nipple-areola complex which is wide. I also recommend going behind the muscle not over the muscle. If you go in from of the muscle you are cutting all the support ligaments of the breasts which will cause the breasts to droop even more.

Best Wishes,

Gary Horndeski, M.D.

From your description you are in the right ballpark with implant selection. Either should give you a nice result and moderate plus will help them from projecting more than you want. Many surgeons have sample implants available that you can "try on" to give you a feel for how you may look after surgery. I've included a video on implant selection that I hope you find helpful.

Try on both sizes, and even 325 to see what you like. You will not look like your wish photos, especially since your breasts' bases are naturally wider apart.