Concerned about size. Would a 450cc implant look large and unnatural? (Photo)

I appreciate your question!

After performing hundreds of breast augmentations, I have found that 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. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you 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 softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is 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. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

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

I think 450 would look fine but it is really a personal decision for you.The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers.   HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter for the average women's chest.  Mentor HP profile saline implants have base diameters that range from 8.8 cm (very narrow) to 13.8 cm (moderately wide).  The majority of women in my practice have base diameters in the 11 to 13 cm range.  The HP implants fit them well.  The moderate implants have much wider base diameters for the same volume (often in the 14 to 15.6 cm range).  These implants are too wide for most women that I treat.  So when the base diameter is measured and correlated with the diameter of the implant, it is most often necessary to use HP implants to achieve the volume the patient is requesting.  At the volume selected, my patient's base diameters are too small for moderate profile implants. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards.  The patients should be allowed to choose the volume.  Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. HP implants can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. At the low end of the fill range, HP implants do not have the upper pole fullness that most people associate with the fake look. On the other hand, a fake over-augmented look can be created with a moderate profile implant if it is overfilled (a common practice for surgeons that commonly use moderate profile implants). In addition, too wide an implant will put the volume past the anterior axillary fold, which in my opinion, looks more fake than upper pole fullness.  So there are many factors that need to be considered.  The experience of the surgeon and the degree to which they explain the options to you is of utmost importance.  Obviously all of my patients look at photographs and we evaluate the look they are desiring in great detail.  For me, high profile implants are the first choice. I rarely find an indication to use moderate or moderate plus implants. This does not make me a better surgeon, or a worse surgeon.  Look at the outcomes and judge for yourself.   The outcomes should stand on their own. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled. Don't let the doctor tell you what would look good on you.  They cannot tell what you perceive to be the best size.

Choosing the right breast implant for your body and goals is very individual. From what you described and your chest, a 450 cc high profile may be slightly large and too projecting for a "natural" upper pole. Preoperative imaging could show you what implants may look like and if a natural upper pole is desired, then consider a different profile, like a moderate or moderate plus height.

A large implant can stretch out the skin over time, so choosing well the first time is important. At our breast augmentation consults, we do a breast exam, measurements, 3D imaging with Crisalix and our standard sizing. When we combine all these things together, the patient has a pretty good idea what she may look like after breast augmentation because we have virtual reality goggles so you can visualize your new appearance. A 450ml implant can look great on certain people, but it might look really big on a tiny woman. So this means that the same implant, can look entirely different on people because the anatomy is so different for each of us. Make sure to visit with a board certified plastic surgeon with a lot of experience in breast.

Thanks for your question and the photos. Given your height you do probably need a little more volume than most to get the look you want. 450CC HP would be way too big and round for you (based on your comments). I bet 375 or 400CC Moderate Plus Profile would be a better choice. As you increase the size (volume) you increase the weight. Your breast has definitely lost some elasticity over the years with children and age. I want patients to be happy. Needing a revision because of malposition and asymmetry is not "happy". I think the Vectra 3D imaging is the best tool to show patients what their expected outcome should look like. With regard to implant profiles, I give the analogy of shoes. If you are a size 8 for example you can wear tennis shoes (Classic profile), wedges (Moderate plus profile) or 4" heels (High profile). Hope this helps. Best of Luck!

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  If you are looking for a natural result, then 400cc is a better choice for you than 450cc.  Moderate profile plus is the most common profile I use in my patients.  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.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

If your goal is a natural result, a high profile implant is probably not the right choice.  It will give the most "upper pole" fullness of any of the implants.  Sometimes, plastic surgeon's want to give the patient the look that they like, not the result that the patient is asking for, so just make sure you communicate your desires clearly to at plastic surgeon that you know is listening.  I wish you luck!

Thank you for your question. Choice of implant size is based on physical examination findings and patient goals. An accurate assessment would involve obtaining a full history and physical.  Unfortunately, there are no standardized bra cup sizes. A "C-cup" from one bra manufacturer may be significantly different from a "C-cup" from another bra company. This variability makes it next to impossible to discuss and predict cup size after augmentation mammoplasty.  I recommend that you review photographs of pre-operative and post-operative breast augmentation patients to help get a sense of what size implants may attain the appearance that you are looking to achieve (the "loveyourlook.com" online database would be a good place to start). Base your goals on the photographic results as opposed to cup size. You can then review the photographs and discuss your desires with your surgeon. Best of luck!

Dear pagosa13,breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

In consultation, after I discuss with my patients their goals, and measure them, we look at pictures of women with similar measurements, with different size implants. This process is very reassuring to my patients in getting a sense of what can be accomplished and if we are reaching their desired result. You should call your surgeon and express your concerns.
Dr. Ted Eisenberg, Board-Certified Plastic Surgeon and Author