500cc too much for my frame?

Question

14cm bwd. PS suggested 500cc smooth round HP Mentor implants under the muscle/Inframammary incision. I desire the largest size possible workout it looking like a very augmented look or the dreaded “2 halves of a coconut cut in half” and stuck on your chest look. I want to be full/large without looking super fake.

Ram Kalus, MD, FACS · Answer

As you undoubtedly know, a precise treatment plan or specific implant recommendation can only be determined with a careful examination and detailed discussion with your plastic surgeon. 500 cc's sounds large for your frame and what you are hoping to achieve. Volume (500 versus 400), is far less significant than implant width and projection. Implant width is similar to shoe size. The implant literally needs to fit into your breast and chest.  It is true that for a given volume a high profile implant will have a narrower diameter, and it is also true that a person such as you with a petite frame will require a narrower diameter implant than a patient with a broader chest or larger frame.

The term “natural” can mean different things to different people and the profile of the implant does not necessarily determine that. You can certainly achieve a “natural” appearing result with a high profile implant if properly selected, but as a rule, the larger the implant and the higher the profile, and certainly if the implant is positioned too high, the greater the chances you will look “augmented” because of exaggerated upper pole fullness or convexity.

Other considerations such as saline versus silicone are also important, as are "round" versus "anatomical" or "form stable" or "shaped", smooth surface versus textured, and softer versus firmer with the different levels of gel cohesivity.

In my own practice, besides a thorough interview process and physical examination with precise measurements, we use onlay sizers within an unpadded bra to help you understand what you are likely to look like in a bra, bathing suit, or T-shirt with a given size implant. In addition, we ask all of our patients to provide us with photos of their desired final look, with images of women’s breasts that most closely resemble the look they are trying to achieve. This serves as a visual guide that thankfully rarely leads us astray. The most common reason for patient disappointment after breast augmentation is size-too big or not big enough. This algorithm which we have been employing for over thirty years has proven to be very successful.

Because all of these factors can leave you quite confused, it is crucial that you select an experienced board certified plastic surgeon whose aesthetics align with your own, and with whom you feel comfortable. Don't be reluctant to seek a second or even third opinion if necessary to be sure and feel confident about moving forward with scheduling surgery. Expressing your desired cup size is notoriously inaccurate, and final breast size is the most common reason for patient disappointment after breast augmentation, either too big or not big enough.

Take your time, do your research. Best of luck to you.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing additional board certified plastic surgeons to ensure that the implants you decide upon are the right ones to meet your expectations. You may wish to "try on" several of the implants so that you can have a better visual representation as to what they would look like, but at a BWD of 14 the 500cc range is likely accurate.. Best wishes!

Gary M. Horndeski, MD · Answer

500 cc implants weigh over 1 lb each, will not fit underneath the muscle and will extrude inferior and laterally. I suggest a more reasonable size such as 200-300 cc implants placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style 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 size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa. USA

Daniel Barrett, MD · Answer

Dear snootle999,
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

Robert M. Tornambe, MD · Answer

I appreciate your concerns with regard to implant size, especially because your body is somewhat petite and larger implants can look fake, especially in smaller individuals. Generally speaking, you do have a modest amount of breast tissue and the shape of your breasts is quite attractive. Your goal should be to choose implants large enough to satisfy your desires, but not so large as to change the shape of your attractive contoured breasts. Larger, 500 mL implants will look unnatural and change the shape of your breasts. Discuss your choices with a board-certified plastic surgeon in your area, best of luck!

Donald R. Revis Jr, MD · Answer

Good afternoon,
That size and profile does not sound unreasonable based on your photos and stats, but the very best way is to take a few different tops to your PS office and try on the 500cc implant sizers with a bra and see how you feel- that really is the best way to confirm and finalize your decision!

Camille Cash, MD · Answer

Implant selection is a detailed process and includes examining the breasts as well as a thorough discussion of your surgical goals. The implant size you are considering is large and may give you an exaggerated look with your frame.  It's difficult to say without talking with you personally what you feel is large enough but not too large that you look fake.  Many surgeons have sample implants you can "try on" to get an idea of how you may look after surgery which may be helpful in your decision.

Michael S. Wong, MD · Answer

Dear snootle999,
Thank you for your questions and photos. The proposed 500 cc smooth round HP Mentor submuscular augmentation will certainly give you significant enhancement based on your frame. I am concerned it may make you appear heavy and may not look as natural. If you haven't already, you might consider seeking out a board-certified plastic surgeon that has the ability to do a simulation with a 3-dimensional camera such as Vectra. While not perfect, it might give you some idea of what you might look like. You will still have some space between your breasts as your surgeon will center the implant below your nipple complexes and the implants could be moved midline while wearing a bra, giving you cleavage.
Hope you find this helpful and wish you well.

Garrett A. Wirth, MD, MS, FACS · Answer

This would be too difficult to answer without a formal consultation as your tissue quality and anatomy is best assessed in person.  While you may be able to achieve the 500 cc volume, there will be a large amount of implant show in my opinion.  That must be the discussion to continue with your surgeon so volume is appropriate to achieve your goals without creating a look you might not like in the end.