Will 400cc HP mentor silicone implants under muscle be to large for me? (photos)

Question

A couple days ago I asked about if a dual plane approach will increase the risk in bottoming out. A doctor said he thinks a 400cc implant would be to large for me. My plastic surgeon didn’t seem to think it would be to large and he wants to use a dual plane approach. I still have time to change my size.. but I really loved the look of the 400cc sizers. Could I get a few more opinions? I will post more photos and angles of my breasts. I am 5’4 125 lbs.

Michael Kreidstein, MD, FRCS(C) · Answer

400 cc implants will likely require release of your inframammary fold so that the implant sits centered under the areola.  When the bottom of the implant is no longer supported by the fold, there arises a risk of either double-bubble or bottoming out.  These problems can be minimized with proper surgical technique and post-operative care, but may result in you needing future surgery for correction.  Be sure to ask your surgeon whether you will need to pay for this revision surgery.

Robert Cohen, MD · Answer

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.
Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Daniel Barrett, MD · Answer

Dear Mizzyway,
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

William Andrade, MD · Answer

Thank you for your question.  Implants are selected based on your breast measurements, tissue thickness, skin tone and other factors that can only be properly assessed in person.  Your surgeon will be your best source of advice.  If you are not sure about the choice, you could book another appointment or seek as second opinion.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate for a breast augmentation.  400cc may be okay for you.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  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

Gary M. Horndeski, MD · Answer

400 cc implants weigh almost 1 lb each.  Your breasts are low on the chest wall and lateral.  Your inframammary fold will have to be released to allow the implant to be centered.  This will result in bottoming out or a double bubble deformity.  I recommend a modified Benelli.  Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage.  At the same time, small implants can be placed.  Aligning the nipple, breast tissue and implant will maximize projection.Best Wishes,Gary Horndeski, M.D.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It is difficult without knowing key breast measurements if 400cc is an appropriate size but based on your height and weight they are on the larger side.  Hope this helps.

Daniel A. Medalie, MD · Answer

HI,I wouldn't worry so much about a dual plane approach as that helps with the slight amount of droop that you have. Bottoming out can happen with any approach and typically surgeons stabilize the infra-mammary fold to help prevent that. In regards to the size, 400 may be a little large for you, but not terribly so. With your height and weight and chest dimensions (from what I can tell from the pictures) I would recommend around 350 ccs. That being said, the extra 50 ccs will not push you into extreme territory. Good luck.Daniel A. Medalie, MD

Donovan Rosas, MD · Answer

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. 
Based on your photos, (while difficult to say for certain without measures) 400 cc does sound a bit large for your frame. Anatomy is the ultimate limiting factor (as I said above).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame

William Rahal, MD · Answer

To answer your question about size and how many cc’s you should get based on the size you want to achieve, first you need to take into account what's known as your base width diameter.
Imagine lying on your back and drawing a circle around your breast. If you were to draw a line across that circle, it will be a given length. Your plastic surgeon will measure this length, which is called ‘’base width diameter’’ or BWD for short. For women, the base width diameter can go from 9.5 cm to 16.5 cm, or 3.75 to 6.5 inches. As you can see, there is a very wide range. 
For example, a 400 cc implant on a woman with a BWD of 10 cm is very different than 400 cc for a woman with a BWD of 15 cm. On one it may be enough volume, and for the other it may be much less than the desired result. 
As far as the placement of the implants, placing them under your muscles - this is still the most popular technique for a variety of reasons, one of the biggest advantages is that it prevents rippling and it also hides the implant better. It is probably still recommended to replace the implants under the muscle, but a discussion of your goals during the consultation will help determine the final position.You should consult directly with your doctor if you are having doubts.
Thank you for reading and best of luck on your journey!

Will 400cc HP mentor silicone implants under muscle be to large for me? (photos)

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