Should I go with 450cc to get the 425cc sizer look?

Question

I'm 5'4" and weigh 107 lbs. My surgeon suggested high profile mentor gel implants that will be placed under the muscle. I loved how the 425cc sizers looked. Should I go with 450cc to get the look of the 425cc sizers?

Jed H. Horowitz, MD, FACS · Answer

Factors which contribute to the outcome of Breast Augmentation are #size, #shape, and #profile. The #profile is determined by the amount of #projection versus roundness that the you desire, as well as the #size of the implant and size of your chest. Also, the placement or incision location will also have an effect on profile. This may also provide some insight. If a woman wears a size 36 AB bra and would like to be a C cup, which is the average size that women wear and the average size bra that is sold, she needs a volume of approximately 350 to 390 cc to make that change. This becomes less if she's wearing a 34 bra, because it has a smaller strap size and the cups have a smaller diameter. A smaller diameter implant would then be a volume of approximately 300 to 350 cc. In the same way if she was more petite, maybe a double zero or size one and wore a 32 AB bra, then to become a 32C cup she would only require about 250 to 300 cc. The profile is determined by the amount of projection versus roundness that the you desire, as well as the size of the implant and size of your chest. As much as it's important to know what size bra you currently wear, the strap size is important to know as well. It affects the diameter of the cup and subsequently the diameter of the #breast implant that you choose. In my practice, about 15-20% of the patients are good candidates for silicone #shapedimplants.#Subpectoral or #submuscular implants refer to placement under the muscle which still remains the most common placement in the United States. #Submammary or #subglandular implants are the placement under the breast tissue in front of the muscle. This tends to more common in Europe and South America. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift often have the implant placed above the muscle, although another option, #DualPlane, has become more popular. In the Dual Plane method, the implant is placed under the pectoralis muscle but the breast tissue is also release, in part, from the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding.

Austin Hayes, MD · Answer

25cc is unlikely to make a significant difference in the appearance of your breast augmentation. It's a question that's best directed to your surgeon, but in general I recommend that patients who are undergoing a submuscular implant go one size up from the sizer that they like in the office. The muscle can flatten the implant slightly and make it appear smaller.

David C. Yao, MD, FACS · Answer

Thanks for asking. In most cases, a 25 cc difference will not produce a significant major appearance difference. I encourage patients to pick the implant size based on their goals and their body type and measurements. A frank discussion with the PS is key. Best wushes

Benjamin Schlechter, MD, FACS · Answer

Depending on the patient's breast shape I typically use the Vectra 3-D imaging device to help give the patient an idea of what the breast implants will look like.  Typically, I use a bra with gel implant sizers.  In your scenario if you like the way the 425cc sizer looks then I would recommend doing the 450cc implants to give you a similar look as the 425cc implant placed against the chest.  Typically, once the implant is surgically placed inside it doesn't have quite the same projection and appearance as when it is help up to the chest.  Once in place the implants are more natural looking.

Justin West, MD · Answer

Hi and thanks for your question. As others have already said, there isn't much of a difference between a 450 and 425 cc implant. It won't be the difference between a result you like and a result you love. As the patient, the most important thing you can do is communicate to your plastic surgeon what your goals are. A great way to do this is share photos of results you like. Once you've made your goals clear, your surgeon will figure out which implants are most likely to help you achieve the look you want.  Good luck.Dr J

Benjamin Van Raalte, MD · Answer

Generally the sizer will look larger on you than the final implant. If you think it is slightly small or just right later it will look smaller. If you think it is just right or a little large it is usually fine. Older patients generally should be more conservative, younger less conservative if debating between sizes. Gel even looks smaller than saline after surgery. Of course the size is dependent on the width of your chest, the skin laxity (for fitting the projection of the implant) and your desire. Some patients cannot fit the desired implant if the skin is tight and others need a larger implant than they initially thought. It is fitting these measurements that get results, so one size does not fit all. A 425 can  look completely different on one patient than another. If you are 5 ft 4 in and 107 pounds and never had children 425 would be a very large implant unless you had children . If you were 5 ft  8 inches, 150 pounds, and had 3 children 425 cc could be too small.

Patrick L. Basile, MD · Answer

Thank you for the question. My experience has shown that when a patient finds a size they like with the sizer you should go one size up from that to achieve a similar size post-op. Talk with your surgeon about the different profiles as well. By your height and weight you sound fairly petite so a high profile or ultra high profile implant will give you the size you want without being too wide.

James Nachbar, MD · Answer

Thank you for your question. I understand that this is a big decision. Whatever you select will likely be something you will have to live with 24/7 for a long time. However, the good news is that Breast Augmentation is one of the best procedures in terms of patient satisfaction. Studies have shown that about 95% of patients are happy with their surgery, so the chance of regret for having had the procedure is quite low.In my own practice, the comment I typically get after surgery is that the patient wishes she had not waited so long. The most common concern is that they wish they had gone a little larger, but I would note that it is one thing to be focusing on the breasts and deciding that they could have been larger, as opposed to living with them 24/7. The size that is fun on Saturday night also has to be ok in church on Sunday morning!Using sizers in the preoperative evaluation is a very helpful technique, but can be a little hard to use, because the sizer is on the outside of the breast, whereas the implant will be inside, and will be "squished" by the overlying muscle and breast tissue.  There is no one answer to this question, and it will depend on a number of factors, including how firm or soft your breasts are, whether the sizers are round or shaped to fit on the outside of the breasts, and how tight the bra you are using is.Another excellent technique to help you plan the surgery is 3D Breast Surgical Simulation. We had the first 3D Breast Scanner in Arizona, and are now on our second generation. While, again, this does not show the exact appearance after surgery, in my experience it has been helpful to show the desired volume.In addition to simulating the appearance with different size implants, the 3D systems also give you computerized measurements of the breasts, including breast width and an estimate of breast volume on each side.While I am aware that some surgeons make the final decision on implant size in surgery, that has never been my practice. Except in unusual circumstances and secondary surgery, I believe in allowing the patient to decide (with my help) on the size and type of implant that they want. Although you can use sizers in surgery, the plain fact is that the appearance in the operating room (and for weeks and months after) is nothing like the final result, which is seen only after the muscle and tissues stretch out to accommodate the implant. Look at the many photographs of early post-operative breast augmentation results on this website to see what I mean.The surgery is not for the surgeon, and it is not the surgeon's aesthetics we are trying to please. There is always a range of implant sizes and types that will work anatomically for any patient, and it should be the patient's decision as to the implant. I have seen too many women in my office complaining that the surgeon who did their procedure did not use the size they were hoping for.So, take your time making a decision you will be happy with, bring in some photos, try on some sizers in a bra, and get a 3D Surgical Simulation. And pick your surgeon carefully. If you do that, you will be well on your way to a result you will be pleased with for years to come.

Tom J. Pousti, MD · Answer

Thank you for the question.  Be careful that you don't “overthink” breast implant sizing concerns ( keep in mind that the “sizers  look" does not necessarily translate into the breast augmentation look achieved). Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical.  
Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation 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. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  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 "C or D cup” etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  Again, the use of computer imaging has been very helpful during the communication process, in our practice.
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,  after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast  augmentation surgery concerns) helps. Best wishes.

Kimberley Lloyd O'Sullivan, MD (retired) · Answer

Sizing an implant is very difficult when you put one in your bra because the tissue overlying the implant will also impact the final result. If you have a floppy breast with a pocket it will fill it nicely and look great.  If the breast tissue pocket is minimal, the implant will sit high immediately and settle over the course of a few months.  As the breast tissue pocket stretches, the shape will become more natural.  Ultimately, the breast will settle into your own body's infamammary crease.   By your height and weight, it sounds like you are very slight in size and therefore do not have much breast tissue on top of the implant.  The implant will show more in this case and be the size of the ultimate breast.   People say, if you are on the edge, go bigger than smaller, however, if you like the size of the 425, I would go with 425 because that is what you will show since your breast are not full. What I do is reoperatively, I go over the look the patient is hoping to have by looking a photos from magazines like Perfect 10 or play boy to determine the ideal size.  I then consider the patient's breast tissue quantity and the quality of the breast pocket. From this I can recommend the likely size that will create the patient's desired look.  In surgery I may use the sizers to confirm the best match and then use that implant. If you are set on a size, just go for it and enjoy!  Realize also that implants are very heavy.  So although there is a subtle difference in appearance of the 25cc, it may be more noticeable in weight of implant.

Should I go with 450cc to get the 425cc sizer look?

Answers (11)

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