My choice in implants does not increase in increments needed for my off-set size. What to do?

I am a 32A looking to be a full C, 5'4, 128lb. At my consult I decided to go with Mentor Smooth Rnd HighProf implants (width approx 12cm vs 14cm). Sub glandular. At the consult we discovered that my R breast is apprx 25cc larger than L, requiring a 25cc smaller implant for my R. Placing 475cc on the R and 500cc implant on the L, into the bra, seemed to look even. Although, I want to increase in size. These implants only go up in increments of 50cc after 500. Any recommendations?

Doctor Answers 10

Solution for asymmetric breasts

Its not clear how you "know" you have a 25cc difference. Is that an estimate your surgeon gave you? When you have implants in the 500cc range, 25cc will not make much difference. Your surgeon might consider using sizers during the surgery and then using his best judgement. Realize that most women's breasts are not exactly the same size. A small difference is usually not an issue. Best of luck.

Paul Wigoda, MD

Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 24 reviews

I am concerned about the difference in size of my breasts and implants

Thank you for your question - it is a very common concern! In general, it is the profile of the device that will determine your final outcome. Small changes can be seen between different sizes in the same profile but nothing that would change something as significant as a cup size. So for example, the difference between 30-50cc is approximately a sip of coke and would not contribute significantly to the overall final size. Ultimately, perfect symmetry is not possible and small differences are to be expected after surgery. If you felt your surgeon understood your goals then I would have confidence in his/her judgement and recommendations. I hope this is helpful.

Breast Augmentation : Information

 Dear Ms. Mommyofone2,

Thank you for your story, question and photos.

Breast appearance, size, filler material , shape and implant location is a personal choice guided by the experience of your Plastic Surgeon. Your SPECFIC breast anatomy will
dictate some of your choices.

As far as size you know all bras are not equal in "cup size" measurements.
"Cup size"is a very crude and non standardized measurement and varies by bra manufacturers. Thus actual cup size you eventually are measured at is not as important as your body proportions as it relates to your desired breast size

My specific responses are:
A)Realizing there are no standard bra (strap/cup) sizes, purchase several bras (full bodied and no padding) of the strap and cup size you think you want to be.
B)take a measuring cup (1 oz=30cc) place rice in a nylon. Therefore 10 oz. = 300cc...
C) try on various volumes of rice with some form fitting clothes.
D)if implant is placed under the pectoralis muscle I usually add 10% volume to what the patient chooses.... To compensate for the muscle pressing down on the muscle and for
the naturally settleing of the implant which often makes the breast appear smaller 2-3 months after surgery.

2) profile of implant:
A) for the same volume the higher the profile the narrower the base width.
B)there is very little difference in projection between a moderate to high profile implant
thus little affect on how the actual nipple will look.
C) the base width of the breast should equal the base width of the implant
D)thus I personally chose the profile based on the patients chest measurements,
(a high profile on a wide chest may not result in the cleavage desired and
conversely a low profile on a narrow chest may result in implant in the outside arm
E)Cleavage is largely determined by your anatomy. This can be optimized by choosing the best profile implant and postoperative implant displacement excercises towards the midline of your chest.

3)Shape of the implant:
A) for the vast majority of cosmetic patients I recommend round implants
B) reconstructive patients shaped/form stable implants are often used

4)Placement decision of implant(subpectoral, dual plane, or suprapectoral) will be determined based on your anatomy and long term goals and benefits.

5)Filler Material
A) silicone gel feels more like breast tissue, less potential rippling, comes prefilled cannot adjust size intraoperatively and larger incisions to place compared to equal sized (non prefilled) normal saline implants.
B) normal saline implants can be adjusted in size intraoperatively, if ruptures normal saline absorbs, potential increase rippling compared to silicone gel, smaller incision to place normal saline implants as compared to prefilled silicone gel implants.

I suggest you collect several nude model photos of the goal breast shape you desire and schedule several consultative appointments with Plastic Surgeons who are experienced and is Certified by the American Board of Plastic Surgery and ideally members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

My best wishes,

R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Use the same size implants in each breast

Very simple solution.  I would use the same size implants in each breast.  If the total is 500 cc versus 525cc you are talking about a 4% difference and I doubt you will see that.  See what your surgeon says before proceeding. Remember, that 30cc is about 2 tablespoons.

Breast asymmetry

 With saline implants, it is much easier to achieve symmetry on the table. By simply not closing and leaving the filling ports in, with the patient in the sitting position, you can add saline to one or the other implant to make the symmetry better. Having said that, as you add 300 mL to a 200 mL breast it's very difficult to see a 25 mL difference. Trust that your plastic surgeon will try their best to get it right. good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

Mentor Breast Implants

Hi Momo,
     I think you are on the right track just the way things are.  If you ask ten PS the same question,  you will get 11 answers!  You are an A.   Most PS say a cup size is about 200 cc.  So for you to go from an A to a C, by the book, you would require 400 cc.  You are well above this.  Our average size is 350 cc, based on 7,000 implants over the past 12 years.  I like you are using Mentor high profile.  This should fit your better.  You are not a large person. I am sure if you are in Atlanta, you probably have a top notch BA PS.  All in all, return to your PS and talk more and try on implants more, but I would stand pat. I like your plan. 
     Here are a few more tips for you (which may or may not apply) because this is perhaps the hardest decision for a patient to make, as well as the surgeon. Also see the video attached to my answer. We spend up to two hours for our BA consults to be sure there is careful communication. We do a full exam in front of a full-length mirror taking six exact measurements. We put your photos on a large computer screen for imaging, and go over your “ideal-size” photos. We then save this information to your password protected “web account.”
First and foremost the implant should fit the dimensions of your breast and tissue cover. Balancing the implant to your over-all body shape and tissue cover is essential.The main thing is to have the diameter of the implant fit the diameter of your breast "foot print". The average size chosen over our last 7,000 breast implants was “350cc”. BUT, 90% of our patients tell us they wish they were bigger a year after BA. (We will see you every year for routine checks at no charge.) It’s like your mind incorporates the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc. You can try on implants in the office by placing them into a special bra. The implant is also flattened somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for flattening of the implant in the partial sub-muscular pocket. Once you decide on a size you like, then add on 25cc, because in real life the implant will be flattened slightly by your tissues. Multiple measurements need to be taken to fit an implant to your exact anatomy. Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer. Then you and your surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan. Keep in mind larger implants tend to have more problems over the years. Since silicone implants wrinkle less than saline implants, they might be your best bet.
You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra. Wear this around the house for a while, and see what you think. Implant size must square with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wall are taken (seven in total). Implant size selection has been an issue of much discussion.
Therefore, I use a wide variety of methods, but the implant size is always established preoperatively. Also, patients are advised to bring reference photos demonstrating their ideal size and shape. A photo album of patient pictures is maintained to assist them. These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery. In determining the final size selection, I always place the highest priority on the preoperative measurements and potential tissue cover. Finally, your verbal requests are factored into the analysis.
We use the quick-recovery approach, so click on the web reference link below to have this explained and you can see the list of Quick-Recovery (Flash-Recovery or Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery journals. It is a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs. It causes far less trauma to surrounding tissue than traditional approaches, and it dramatically reduces pain and recovery time. In published studies of BA patients, 95-percent of women interviewed after the procedure returned to normal daily activities within 24-hours. Quick-recovery BA is not a “gimmick.” These specialized techniques, which actually speed recovery and get you back to your daily routine, kids and work, are published in our plastic surgery journals. Because these PS journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science. Therefore, these are sound techniques, not marketing hype.
Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). Also, ask if the PS has an established, high volume breast augmentation practice, performing several hundred breast augmentations each year. Be sure the PS has been in practice for a while, about 20-years might be a good gauge. Does the PS offer all three incisions? Discuss the implant type (gel or saline), shaped "gummy bear" or non-shaped, smooth or textured, implant pocket (over or under the muscle) and the "quick-recovery approach." Ask to see their before and after photos if you didn’t see any on their website. If they are experienced, they should have several 100 breast implant patients for you to view. I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you. You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.
All the best, “Dr. Joe”

25 ml volume difference is not of sufficient magnitude to warrant implants of different dimensions

The decision to correct substantial volume asymmetry of the breasts often involves placing implants of different dimensions. While the volume of the breast may be better matched in a bra, the different implant dimensions may lead to different shaped breast when nude.  Such an outcome is often aesthetically inferior than to have simply accepted minor volume differences in favor of similar shaped breasts.  When to use different sized implants to address volume asymmetry is best left to the judgement of your surgeon.  In my practice, a 25 ml volume difference is not of sufficient magnitude to warrant implants of different dimensions.

Chen Lee, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 16 reviews


First of all, if you are aiming for a full 32C, 475 or 500 cc will be plenty.  You might end up more of a D cup with that volume, especially with a 32 band petite frame.

If you really want to be larger than that, you'll have to accept the slight difference in size that the extra 25 cc increment gives.  It sounds like a big number, but in reality, it's only the size of shot glass - spread out over the entire breast.  It would be very subtle.

All the best,

My choice in implants does not increase in increments needed for my off-set size. What to do?

Ultimately, I think that it will be in your best interests to ask your plastic surgeon to use his/her best judgment when it comes to selecting breast implants that will best achieve your desired outcome, when it comes to breast size and symmetry. In my practice, this is accomplished through careful preoperative communication and after the use of intraoperative sizers. If your breast asymmetry is minimal, you may be best off accepting the slight asymmetry and utilizing the same size/profile of breast implant. If, on the other hand, the use of different sizes/profiles of breast implants will improve your symmetry, then ask your plastic surgeon to do so. Keep in mind, despite best efforts, absolute symmetry will not be achieved. Best wishes.

My choice in implants does not increase in increments needed for my off-set size. What to do?

In my experience I do not use different size implants unless the difference between the breasts is 50cc or greater. I do not try to compensate for 25cc difference. Ask your surgeon to place inflatable sizers during surgery to see how much difference in cc it takes for symmetry. The 500cc is a large implant and should be adequate.

Be sure there is no nipple asymmetry or that one breast is not lower-if there is there will be differential drop of the implants which will exaggerate the difference. Please read the link below for more on asymmetry:

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.