5'1" 450cc silicone too big?

Question

I am 5'1", athletic build (strong legs/butt), with small but nicely shaped breast (small B). I interviewed several surgeons and tried on sizers at each. Two surgeons agreed 450cc round silicone mod-prof above the muscle would be best for me. The 3rd thought 400cc round silicone mod-prof below the muscle was best. I decided on getting my surgery with one of the 450cc above muscle surgeons but am starting to second guess myself! Help!

Larry S. Nichter, MD, MS, FACS · Answer

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. 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 difficult to make this determination. For example, the existing 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 breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size 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). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants

Emmanuel Mallol Cotes, MD · Answer

Thanks for sharing your concerns with us. I recommend you to send your photos to us cause there are many other parameters beside the height lo determine the volume of the implant.Kind regards

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you  is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance.  Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the top (upper pole fullness).

Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.

These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.

Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.   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.  This entire surgery
can be performed with a small incision technique.  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.   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.
Harvard-trained plastic surgeon

Nelson Castillo, MD · Answer

Thank you for your question and I can understand your apprehension.  Unfortunately without a full series of photographs and a discussion as to your goal look, it is impossible to make an implant recommendation.  There is unfortunately no correlation between cc size and eventual bra cup size.  As a result it is important to be able to communicate what shape and size you'd like to obtain and your plastic surgeon can help you select an implant from there.  Ultimately you should go with the surgeon with whom you feel most comfortable in asking questions as they should be providing you with the reassurance on your choice. Hope this helps.

Steven Wallach, MD · Answer

If you have narrowed it down to a few sizes, then you can do a baggy test to get a rough idea of the volume you desire. Best of luck.

Andrew Gear, MD · Answer

It all depends on your breast measurements, skin quality, etc.  If you violate your God given anatomy too aggressively, it can lead to trouble.  You won't necessarily know the truth of this until years later.

Robert S. Houser, DO · Answer

I have to problems with your plan. First of all, breast implants on top of the muscle may look good for a few years, but may ultimately fail as they are at higher risk for developing capsular contractor and visibility of the implant. For that reason, under the muscle is best. Also, that is a large implant for a woman with a small frame.  Large breasts will sit lower on your torso than small ones, robbing you of your waist. It can quickly go from looking curvy to looking heavy as it steals from your figure. Good luck.

Victor Ferrari, MD, FACS · Answer

With such limited information, it's not possible to give you good advice online.  I would recommend that you consider the following in your decision as to what size to pick.  1)  Going over the muscle, larger implants have a higher chance of visible rippling.  2)  Going over the muscle has a higher risk of synmastia (uni-boob). 3)  Larger implants have a higher risk of permanent loss of nipple sensation.  4)  Larger implants (i.e over 350c) have a higher risk of sagging over time.  5)  Larger implants have a higher risk of stretch marks.  6)  Larger implants have a higher risk of neck and back pain.  I'm not trying to be a "Debbie Downer", but you need to consider all these issues when selecting an implant size.  Discuss the pros and cons in detail with your PS.

Tom J. Pousti, MD · Answer

Thank you for the question. Despite your good description of body type and goals, online consultants will not be able to provide you with specific enough advice to be truly helpful. 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, in bra sizers, and computer imaging)  as well as careful measurements (dimensional planning) will be critical. Make sure you carefully consider,  the short and long-term pros/cons associated with breast augmentation done in the sub muscular versus sub glandular position. You will find a lot of information regarding this topic on this website.I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.

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. For example,

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.

5'1" 450cc silicone too big?

Answers (12)