34A to 34D - The Search for the Illusive Perfect Breast Implant
I completely agree with the great answer posted by my colleague, Dr. Soto.
A little knowledge is indeed a very dangerous thing. Armed with conflicting advice from every friend who either had or wants a breast augmentation, buzzing with numbers and sizes copied from tens of websites and confused from tens of before-after photos - most women on this and other sites literally spew out a series of their measurements and desired cup sizes and implants - hoping to have us put it all together.
But - there is no escaping the ultimate truth. Your perfect breast implant largely depends on your current anatomy (chest size and shape, breast size, location and shape0 and your likelihood to accept short-lasting, less than natural appearing results.
Although PHYSICALLY speaking any implant can almost always be placed in most women does not mean that they should be. Instead, the question should NOT be what cup size are you going to be (a very inaccurate unrealistic question at best) - but which implant would BEST fit your anatomy and apt to give you the best outcome WITHOUT looking fake and unnatural.
To have a natural appearing breast augmentation, your implants MUST sit exactly under your nipple areola complex AND be covered by your breast tissue. If there is not enough cover, the ripples in the implant shell WILL BE visible and palpable (especially along the sides).
If the nipples are widely separated and / or on the sides of your chest - so will the implants. Any attempt to bring the implants closer in such cases would result in sideways "looking" falling nipples.
I DO think you should try sizers and see more or less what you are getting. I also think you should pick the SMALLEST implants you may be happy with (less skin stretching, less breast tissue wasting, less breast sagging) rather than the biggest that can be shoved in -based on uninformed opinionated Internet comments.
Pick a board certified Plastic surgeon (www.plasticSurgery.org) and make sure you know not only the positives but also the drawbacks for each implant.
Dr. P. Aldea
I need help choosing a breast implant
One of the things I find most interesting is the amount of misinformation the average patient must sift through when researching breast augmentation surgery. In particular, I think that many patients become overwhelmed with implant choices and the abundance of information about these options available on the Web.
This is complicated once they contact a surgeon or two for information about the implants, and which is most likely to give them the result they desire. Somewhere along the way, opinions expressed by a surgeon are perceived as fact by a prospective patient (because of the surgeon's reputation or the apparent strength of his/her opinion), who then becomes more confused when she hears a differing opinion.
This leads to ridiculously technical questions being posted on sites like RealSelf and others, such as:
"I am 5'5", 125 lbs, my measurements are 34, 22, 36. I have had 3 babies, all by C-section, and I breast fed two of them. My breasts sag a little, but not as much as some women I have seen. I want to have a full C-cup breast. Should I get 325 cc Allergan 410 style implants, or Mentor 350 cc Moderate profile implants. Projection is more important to me than a natural shape..."
Every time I get one of these over-thought questions, I always think the same thing... ???????
Let's take a big step back from the trees here and take a look at the forrest in front of us, shall we?
Fundamentally, the reason any woman seeks breast augmentation is because she wants to achieve a certain appearance, right? Let's repeat that- to achieve a certain appearance. NOT a certain bra size, or a certain implant volume, or even a certain implant type. When you first stared to think you might want an augmentation, you didn't think, "I would like it if I could have 350cc implants"... You probably thought, "I would love to look like that (after admiring another woman's breasts)..."
So if we can agree that what you are really after is an appearance you would be happier with (as I always tell my patients), let's make the desired appearance the focus of our communications...Let us both ignore bra sizes (which are not standardized and the choice of which is very arbitrary) and implant types/sizes (for now)... Let's first understand what you want to look like. I think you would agree that if we are able to make you look the way you wanted to look, the letter on your bra and the number on your implant is lees important, right? Help me understand what you want to look like, and I can give you a very accurate recommendation of options for achieving that appearance -- provided a careful physical examination has also occurred.
Why is the exam so critical? After all, can't we just put small implants in women who want small breasts and larger implants into those who want larger ones?
The exam is critical, because for any one particular woman, there are only a few good choices of implants available, regardless of her goals, and these options are arrived at by taking careful stock of her breast tissue, skin, and frame. In other words, your anatomy will, to a large extent, help us understand the implant options that would make you look the best. This is the "One Right Result" concept. The taking of these measurements is so important, I do it myself every time, and based on these measurements and my patient's goals, then make recommendations regarding the implant options available to her (as these options would be different for different women).
While (as with any aesthetic procedure) no guarantee of outcome can be given, you are much more likely to achieve your desired outcome if you focus on communicating your desired appearance successfully with a skilled and experienced, Board Certified Plastic Surgeon than by over-researching the implants and micro-managing the details of the surgery. In fact, I can think of no better way for you to increase the odds of you ending up dissatisfied.
So don't over-think it. Think carefully about the appearance you want, communicate it carefully to your surgeon (using photos if possible), and make sure that the implant choice arrived at by the two of you together is based on both your anatomy and your goal. You'll be happier and the process will be less stressful!
Breast Implant Size - Look at before and after images. The sizes can be different based on body shapes
Look at my breast augmentation gallery of 100+ women (link below). You will see that different sizes and shapes of implants look very different on women of different body types
Here’s one of the most important things to understand about breast augmentation – maybe THE most important: based on the breast ‘soft tissue envelope’ that you are starting with, and by that I mean the breast skin and subcutaneous breast tissue that will cover and conceal your implants, there is a limited range of implant shapes, dimensions and volumes that will produce 1. A natural-appearing result, which in turn provides you with 2. A very low likelihood of needing a reoperation (or a series of reoperations) for the problems associated with overly large breast implants: visible implant folds and ripples, implant malposition (usually ‘bottoming out’ and/or ‘lateral drift’), lower pole skin stretch deformity, easy implant palpability, stretchmarks and capsular contracture.
And yes, I do believe overly large implants have a higher rate of capsular contracture, for any one or all of the following reasons: a possible direct mechanical adverse effect on breast soft tissues; the fact that the bigger the implant is (i.e. the lower the ratio of natural breast volume to implant volume) the more obvious a mild or moderate contracture will be; and what I think is a high probability that surgeons who are willing to place unnaturally large breast implants are, as a group, less likely to be compulsive about using the intra-operative measures and techniques that have been shown to lower the incidence of capsular contracture.
If you want a natural-appearing result that is stable in appearance over time, find a surgeon who uses biodimensional planning principles and who recommends a smaller volume, moderate projection implant. Don’t obsess about ‘C’ or ‘D’. Just ask the surgeon for the fullest volume breast implant that your natural breast tissue can effectively conceal (and not just for the short term but over time) based on biodimensional planning. You’ll get an outcome that looks full and beautiful but also natural, and that doesn’t cause you problems that lead to frustrating reoperations with a few months or years of your augmentation surgery.
Height and weight a factor in determining size
Height and weight are some of the determining factors for breast implant size. Another important factor is the original size of one's breasts before surgery and what one wants to achieve after surgery. Tall slender women would probably need implants that are smaller than tall heavy set women. But it is best to determine the size at the time of the initial office visit and consultation.
3D Imaging May Be Helpful
One of the
most important decisions facing breast augmentation patients is the size of
breast implants that will be used. Most
patients are striving for harmony, balance, and proportion with the surrounding
anatomic structures.Typically, they
want a natural look with some fullness in the upper breast area.In women who are tall, this usually requires
a larger implant.
Most patients tend to speak in terms
of cup size.Unfortunately, cup size
means different things to different people.This represents a problem because cup size doesn’t necessarily correlate
with the cc volume of breast implants.This potentially creates communication problems when talking cup
In an effort to determine breast
size in a more objective manner, we utilize external silicone sizers and the 3D
Vectra computer imaging system.These
systems help patients visualize what their breasts will look like with a
specific sized implant.Patients find
this to be extremely helpful.
The ability to visualize your
projected surgical result alleviates much of the anxiety associated with this procedure.It’s important to remember that final
adjustments in the size of breast implants will be made in the Operating Room,
based on anatomic considerations.
Think about your measurements and goals of surgery
Have you tried on sizers? This can help you get a better idea of how you may look.
I use a technique called dimensional breast augmentation which involves taking in a number of factors and measurements, so each patient is unique. That being said, given your height, weight, and your activity level, along with the fact you are considering a lift, I would say you are probably not that far off in choosing an implant in that range. Best thing to do is to see a qualified plastic surgeon that has good breast expertise.
Talk to your surgeon to discuss your concerns. Your surgeon may have helped you determine the most suitable implant size based on your measurements and goals. These are all unique to you. Be careful about choosing a size based on what others have.
BEST IMPLANT FOR TALL WOMAN
Every woman’s body is unique so an implant size should not
be completely based on what someone else has. An implant size alone does not
determine your breast size after surgery. The amount of breast tissue that you already have will also determine the
breast size after surgery. A 500cc implant in one woman is not going to
look the same in another woman even with the same height and weight or bra size. To avoid miscommunication and improve patient
satisfaction after surgery, I have my patients try on different implant sizes
to better visualize the look my patients are trying to accomplish. Without a physical exam it would be difficult
for me to give an opinion as to whether or not your body would be able to hold
a 500 cc implant so I recommend scheduling
some time with your plastic surgeon before surgery to revisit your implant selection. Perhaps your plastic surgeon has a specific
reason that the 410 cc implants were chosen.
Be well and good luck!
Appropriate breast implant size for tall woman?
Hello! Thank you for your question. In general, implant size does not correlate with bra cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance.
Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory (e.g, implant type, incision, placement, lift, etc). I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width.
Hope me that this helps! Best wishes for a wonderful result!
Predicting Breast Augmentation Size
Good luck with your surgery!
It is very difficult to determine the exact size and shape implant you will require without an examination by a board certified plastic surgeon. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be tough to answer your question. For example your native base width of your breast will determine in many cases the maximal volume per implant profile that you can accommodate. To illustrate a 100 cc difference may make a significant difference with a narrow base width, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors. I always find it helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. I bring these photos to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to achieve their wishes.
I personally order more than one set of implant sizes and use sterile sizers placed in the pocket during surgery to know in advance exactly which implant would work best for you. Software morphing programs can be helpful in some but not all cases (e.g. doesn't work well in my experience with existing implants, sagging or asymmetric breasts).
There is no way to guarantee a particular bra size. Bra sizing varies greatly between bra manufacturers and a C in one bra will be a D in another. What matters more than the assigned bra size is the way the implant looks on you. The best option for your body and aesthetic goals can be determined in a thorough implant sizing session.
Implant sizing depends on several factors. One of the most important factors is your breast width. Generally, your surgeon will measure your breast width, and then provide you with a range of implant sizes appropriate for your native breast size. There are more nuances to it than just what I've described, but this approach works for most women.
I usually have my patients bring in a large bra and a tight t-shirt to do sizing. I'll then choose 3-4 implants that I feel are appropriate, and have my patients place them in the bra under the tight t-shirt. My patients can then look in the mirror and get a good sense of what they will look like with the provided implant sizes. My patients like this approach and get a great idea of how they will look.
By using this technique, your surgeon can outline a range of appropriate implant sizes that will be aesthetically pleasing, and you make the final decision.
I hope this helps. Good luck!