I am very petite and am scared my implants will make me look top heavy (Photo)

Question

Measurements: 4’11 20 y/o 95 pounds 32 full A/small B cup size Surgeons recommendation: 350 cc/silicone/high profile extra fill/under the muscle I am scared that 350 will make me look top heavy. I tried on the try on implants but honestly I couldn’t decide on a size because they all looked weird. I usually judge boob size on cleavage not how far it goes out so I was confused and the 350 cc made me look top heavy but it was his recommendation. I like cleavage but want to be proportionate

Leila Kasrai, MD, FRCSC · Answer

If the implants in the size you tried on looked weird to you, then please discuss your concerns with your surgeon. A smaller size may be more suitable for you. Regarding cleavage, please note that breast augmentation can only do so much. If you’re hoping to have more cleavage, implants would not be effective.

Jacqueline Rose Makerewich, MD · Answer

Hello, thank you for asking us this question. It is a very common question and many people express the same concerns when it comes to choosing size. I would see if you can go back in for some more sizing to finalize on a breast size. You can also discuss whether or not a moderate profile or high profile implant will help you in the cleavage department.

Laurie A. Casas, MD, FACS · Answer

Thank you for you spot on question. 
As a female Plastic Surgeon, I share your concerns. 
You are very petite, so the key is that together with your Plastic Surgeon,  you understand exactly how the implant YOU choose, will look on your petite body. Please be sure to share your thoughts on what is important to you. If you want cleavage, the implant will need to be wide enough, so that it will give you the cleavage by your chest bone (sternum),  but also be wide enough on the sides of your breasts, because your nipples are a little off center and are off to your sides.
 Please be sure you also share how much upper pole fullness you want, that way your surgeon can help you understand what each profile =projection in each projection category will achieve on your body. There are low profile, moderate, moderate plus, high profile and high profile plus projecting implants. This should help you understand that there are many options that will help you achieve your goal.  Very often petite patients, like the case I show on the home page for breast augmentation on my website,  is 4'11 and 102 pounds.   She wanted a conservative augmentation, so WE chose a 190cc Low profile smooth silicone breast implant. This is the look that she wanted. The key is that you work with a board certified Plastic Surgeon who will help YOU choose 
1. the implant size in volume(cc) you want, 
2. the implant width that achieves the cleavage you want
3. the width that allows your already lateral nipples to look more central over your augmented breast mound , and a Plastic Surgeon
4. who helps you choose the correct implant projection to get the upper pole fullness YOU want.
All this can be achieved during your in depth consultation. During my consultations I have patients try on different projecting and width implants. I wrote about this in 2010 in our Plastic and Reconstructive Surgery Journal. Here is what I published 
"The finesse in the preoperative implant-selection process evolves as the plastic surgeon allows the patient to actively participate in the process while only offering patients implants to use for sizing that are tissue and dimensionally appropriate in width, height, projection, and volume so that the implant ultimately selected will fulfill the patient's preexisting soft-tissue and chest wall requirements. Many patients will only reveal their unrealistic expectations through this type of patient-centric preoperative sizing process. Three-dimensional imaging may also help to evaluate patient expectations; however, the software is costly.
To achieve high rates of patient satisfaction and low reoperation rates for size dissatisfaction, the plastic surgeon must actively involve the patient. This method does provide the patient with that important decision-making power, but it must be masterminded by the plastic surgeon who has measured and evaluated the objective data from the clinical examination so that the patient is guided to choose the appropriate implant that will safely fill her unique breast dimensions yet provide her with an aesthetic result with which she is satisfied. As always, as plastic surgeons, we must not only merge scientific data with the artistry of plastic surgery but also practice the art of medicine in our approach to patient care. Bravo to Drs. Hidalgo and Spector for reminding us that the patient's desires are a critical part of this implant-selection process." 23.	Casas,LA., “Preoperative Sizing for Breast Augmentation”. Plastic and Reconstructive Surgery Journal, February 2011, Volume 127(2):1006-1007.
Remember if you are not sure, postpone surgery until you are. Also, remember with virtual consults you can talk to other Plastic surgeons to best understand your options.
Good Luck!

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph. I agree that the implants sound a bit large for your frame and based on your anticipated goals.  A moderate profile implant will likely improve your cleavage and side boob better than the high profile and will help to keep the weight down. Hope this helps.

Salih Onur Basat, MD, EBOPRAS · Answer

Hi and thanks for your question. You are a good candidate for breast implant. I recommend round implant with dual plane technique for you. Round implant can give a more natural result with upper pole fullness for your case. You have not enough breast tissue, because of this I recommend dual plane technique for you. In this technique upper part of implant is covered by chest muscle and breast tissue, lower part of the implant is covered by breast tissue. With this combination you can get good result. This operation takes 1.5 hours and can be done under the general anesthesia. You should stay one night at the hospital to get rid of the anesthetic drugs affect. After surgery you should use sports bra and breast band for 6 weeks. Two weeks after the surgery you can start sports but you should wait for 6 weeks to use your arm strongly.
Best of luck.

Donald R. Revis Jr, MD · Answer

Good morning,
350cc will make you quite busty given where you are starting currently- and sizers are the best way to determine the size that makes you feel comfortable, confident and most meets your expectations. I would suggest you try the sizers again before just letting your PS choose your size!

Ram Kalus, MD, FACS · Answer

Thank you for your question and photos. As you undoubtedly know, a precise treatment plan or specific implant recommendation can only be determined with a careful examination and detailed discussion with your plastic surgeon.

First off you are starting at an excellent point with pretty and proportionate breasts that arguably should don't be augmented at all based on your petite dimensions. That said, assuming you are set on a breast augmentation, I tend to agree that a 350cc implant seems large for you.

Volume (250 versus 350), is far less significant than implant width and projection. Implant width is similar to shoe size. The implant literally needs to fit into your breast and chest. The 350 (which profile?) may well “fit” your breast, but the volume and projection are what will determine the “look” you want, similar to the style or type of shoe you would select. It is true that for a given volume a high profile implant will have a narrower diameter, and it is also true that a person such as you with a petite frame will require a narrower diameter implant than a patient with a broader chest or larger frame.  Other considerations such as saline versus silicone are also important, as are "round" versus "anatomical" or "form stable" or "shaped", smooth surface versus textured, and softer versus firmer with the different levels of gel cohesivity.

The term “natural” can mean different things to different people and the profile of the implant does not necessarily determine that. You can certainly achieve a “natural” appearing result with a high profile implant if properly selected, but as a rule, the larger the implant and the higher the profile, and certainly if the implant is positioned too high, the greater the chances you will look “augmented” because of exaggerated upper pole fullness or convexity.

As you alluded you may have already gone through this process, in my practice, besides a thorough interview process and physical examination with careful measurements, we use on lay sizers within an unpadded bra to help you understand what you are likely to look like in a bra, bathing suit, or T-shirt with a given size implant. In addition, and this is critical, we ask all of our patients to provide us with photos of their desired final look, with images of women’s breasts that most closely resemble the look they are trying to achieve. This serves as a visual guide that thankfully rarely leads us astray. The most common reason for patient disappointment after breast augmentation is size-too big or not big enough. This algorithm which we have been employing for over thirty years has proven to be very successful.

Because all of these factors can leave you quite confused, it is crucial that you select an experienced board certified plastic surgeon whose aesthetics align with your own, and with whom you feel comfortable. Don't be reluctant to seek a second or even third opinion if necessary to be sure and feel confident about moving forward with scheduling surgery. Expressing your desired cup size is notoriously inaccurate, and final breast size is the most common reason for patient disappointment after breast augmentation, either too big or not big enough.

Take your time, do your research. Best of luck to you.

Robert M. Tornambe, MD · Answer

Nicole;  You are correct to be careful in choosing breast implant size for a natural result because you are petite and have little or no body fat. However, you do have breast tissue, and your breasts are very small but attractive.
 You can easily obtain a natural result with round smooth implants in the sub muscular plane.​   I do think that 250- 275 mL implants are a reasonable size for your body type and breast base diameter, but physical examination is always needed. I also like to use the implant in brassiere technique to try different size implants to assist patients in choosing the best size for them. Another nice exercise is finding photographs of breast size that you like, and show them to your plastic surgeon.  Be sure to consult with a board certified plastic surgeon.  Good luck!

Daniel Barrett, MD · Answer

Dear Nicole2222222,
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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery