Disappointed with Breast Aug Simulation Results - what implant size and placement would give me upper pole fullness? (Photos)

Question

I’m 29 years old, 5’9 and 160lbs - no kids. I used an online 3D simulator as i’ve been really considering a breast augmentation. I’m disappointed with the results of the simulation and wondering how realistic this is. I want a natural look without them looking “bolted on” or too big for my frame but these look like bottom heavy, saggy breasts. I was hoping for some fullness at the top. Are these realistic simulations? What could I benefit from in terms of implant type, placement?

Daniel Barrett, MD · Answer

Dear coriaz01,

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

Martin Jugenburg, MD · Answer

It’s completely normal to feel that way—3D online simulators can be helpful for getting a general sense of size, but they’re often not entirely accurate. They usually don’t account for your chest shape, skin elasticity, or how implants interact with your natural breast tissue, which is why the results can sometimes look bottom-heavy or unnatural.

For a natural look with some upper fullness, there are a few factors a surgeon would consider:
-- Implant type: Silicone implants, especially those with a moderate profile, often give a more natural slope than very high-profile implants.
-- Placement: Submuscular (under the muscle) placement can help avoid the “bolted-on” look and create a smoother transition, especially for women with less natural tissue.
-- Size & shape: Choosing an implant proportionate to your chest width and body frame is key to balance and avoiding bottom-heavy appearance.

Ultimately, an in-person consultation is the best way to assess your anatomy and discuss implant options, so the result matches your goals of natural-looking, proportionate breasts with some upper pole fullness. Check out this answer's supporting link!

William Andrade, MD · Answer

Thank you for your question.  Recently a published study tried to address your question, i.e., does a 3D breast augmentation simulation actually look like the real result?  They basically asked multiple plastic surgeons and laypeople to look at the 3D images compared with the actual postoperative photos. In the majority of cases, the observers found that there was a "moderate" resemblance.  In a small percentage of cases the 3D simulation did not resemble the actual result, and in a similar small percentage the 3D result looked very similar to the real outcome.   Bottom line, no available technology will reliably simulate your exact postoperative result.  Despite this fact, I still think 3D images still have some value during the consultation process.  For example, they help me explain how differently-sized implants might help correct asymmetrical breasts, or how different implant profiles can affect the shape of the breasts.  In my practice, 3D images are just one of many method to help my patients choose their implants.  Other methods include: 1. trying on breast implant sizers, 2. looking at before-and-after photos of women with a similar breast shape, and 3. taking detailed breast measurements to ensure the patient's desired implants actually match their breast dimensions.  I hope this helps!

Zoran Potparic, MD · Answer

We found that Vectra system we use in our office creates variable results when it comes to accuracy of implant size and shape selection. Usually we start with in person evaluation and a series of implant sizers after surgeon receives information about patient desire; very rarely we relay on breast 3 D simulation for breast implant augmentation. However, our results in 3 D simulation of many other procedures, in particular nose and facial surgery are very satisfactory and close to real results. In person consultation with an experienced board certified plastic surgeon should be your next step. Good luck.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Warren Schutte, MD · Answer

You appear to be a good breast augmentation candidate. Here in office, we would start by allowing you to try on a cc sizer system to see what volume you are liking. It is very important to choose an implant size that you love. From there, along with your breast measurements, we discuss profile and then see where you are aligning on cc size and profile. From your wishes, I would recommend you getting into a high-profile implant for upper pole fullness.I often see the simulations leading to disappointment, and thus do not use them in my clinic.

Gary M. Horndeski, MD · Answer

The implant simulator is accurate. If you simply undergo breast augmentation with your low lying breasts then you will end up with bottomed out sagging appearance breasts. You would benefit from a breast lift using 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 (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired. Your biggest problem is not volume but position and lack of cleavage.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Donovan Rosas, MD · Answer

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing.  Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.  
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
3D simulators are all the rage these days. Technology has reached a point where simulations are photo realistic. However, they are only simulations and cannot predict what you will look like. Tissue stretch is very challenging to model and will have a significant impact on shape and final result.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." Communication is key as you and your surgeon create your custom surgical plan. 
As always, discuss your concerns with a board certified plastic surgeon.

Darryl J. Blinski, MD · Answer

Based on your posted photos, the initial issue is you have breast asymmetry as for location, the nipple complexes if enlarging your breast, this asymmetry will be magnified. Second the volume is slightly different as seen in the photos so different sized implants might be indicated or same size implants in the DUAL plane for more upper pole fullness without showing“bolted” on implants. In addition, I would recommend liposuction of 1 L of super Nate and fat for fat grafting to the upper polls to give a more natural appearance. Therefore, I recommend virtual consultation to get a better understanding of your options. Expect fees to range from $8000-$15,000. Again, best of virtual consult with. 
Additionally, computer or virtual simulation for results can only give a inaccurate idea therefore doing that can confuse you even more

Tuan A Truong, MD, FACS · Answer

Thank you for your question. Simulations, while improving, are only just that - simulations. Final results do depend on a variety of factors, including breast tissue, anatomy, implant size and profile, and implant placement. A thorough discussion and consultation with a board-certified plastic surgeon will be able to answer some of these questions, as well as give you insight into the appearance you are looking to achieve. Good luck with your journey!

Disappointed with Breast Aug Simulation Results - what implant size and placement would give me upper pole fullness? (Photos)

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