How accurate is this Vectra 3D image for breast lift/ augmentation? Are implants in 500cc range suitable for me? (photo)

Hello and thanks for your question/images. Based on your photos, you are a candidate for an augmentation-mastopexy which is a breast lift with the addition of implants. The implants you discuss are very large and will definitely cause the breast tissue to stretch and the breast to drop over time. The sagging and stretching of the breast skin can occur rather quickly which would lead you to be unhappy with your results. I suggest a smaller sized implant. I also suggest keeping the implant sizes the same and correcting the asymmetry of the breasts during surgery with tissue excision to help achieve better symmetry. Please remember that breasts are not twins, they are sisters. Perfect symmetry is not realistic. Your expectations as a patient are very important. 
All the best!
Alex Zuriarrain, MD
Cleveland Clinic Plastic Surgery

HI. I hear your concerns. I do place much faith in the Vectra imaging system. I feel that it's more of a marketing tool than a fair reproduction of an eva;uation. It should never take the place of a plastic surgeon's experience nor decision making. Interesting enough, you state "I selected sizes 460cc for the left and 590cc for the right (based on 3D imaging)." With all due respect, the procedure recommend and size of the implants to be used should have the input of both surgeon and patient. IMHO if the patient choose a size that I don't agree with, I'll simply and politely refuse to perfom her surgery.You are an excellent candidate for a breast lift and have plenty of breast tissue to achieve what you want with or without the use of implants. IMHO you will need the traditional "anchor" type lift.The implants you have chosen are way too big and it won't be long before your breasts are droopy again.
Always seek out the opinion of a surgeon certified by the American Board of Plastic Surgery with years of experience in cosmetic breast surgery. Furthermore request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits? 
How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.
How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications.
In our office we use TouchMD which is a web based program in which patients have the ability to load their picture unto the program. I then evaluate them and can actually draw on the picture to show a potential patient where the incisions would be located and how the procedure is to be realized. It's all done to comply with HIPPA which is the federal law that protects the patient's medical information. Look them up.
I wish you well on your journey. Good luck Dr. PG

Hello and thank you for your question. The best advice you can receive is from an in-person consultation. 
Based on your photographs, the best shape and contour could be achieved with an
implant and a breast lift. Your nipple sits below the inframammary fold
and without a lift in addition to the implant, this will not have a natural
shape.  A breast lift with an implant can result in a very nice shape if
good technique is used.  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 not just a computer
animation system. The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Although useful as rough guidelines and as communication tools, all the modalities currently used to predict what breast implant size/profile will best achieve a patient's goals with breast augmentation are NOT very accurate, in my opinion. The use of the rice test, sizers placed beneath a patient's bra, goal pictures, computer imaging technology… are all useful, but not necessarily as accurate as one would hope.
In my opinion, nothing will replace careful verbal preoperative communication with your plastic surgeon, preferably in front of a full-length mirror along with the use of as many "communication" tools” listed above.
In my practice, I use all of the above modalities and then use intraoperative temporary sizers to help determine the best breast implant size/profile to achieve a patient's specific goals as closely as possible. For this reason, I think it is helpful to have the entire range of breast implant sizes/profiles available in the upper room.Patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars.
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work. 
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "D or DD cup" etc 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. The use of computer imaging may be very helpful during this communication phase.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
Best wishes.

Any computer/3D imager are tools to try to educate the patient on potential results appearances. Understand cosmetic/plastic surgery is more than just surgery it is an art. Any tool is more to sell & educate not an exact predicted to outcomes. That is in general terms. In your case mu over the RS internet I believe yu may need 2 separate operations. First full lift with slight reduction of larger breast. Than allowing 3 to 6 months healing. Followed with the 2nd operation implant insertion (if desired or needed).Best to see more in person opinions.  

Many things to consider here:
1. The images predicting your results would not make me enthusiastic either. You do have a difficult starting point needing a full breast lift to re-shape and tighten the breasts. This is an art form and no 2 surgeons are alike in their talent for this surgery.
2. BIG implants done at the same time as lifts are very prone to complications. Often better to separate by 4 months.
3. Big implants in someone like you with loose lax tissues WILL drop down over a year and lose upper pole fullness
4. Use the same implants always and adjust the breast sizes making the bigger one smaller to match. Having different implants is not wise, apples and oranges. 
5. maybe seek other opinions