BA in 4 Days & Nervous About Size. Is There a Big Difference Between 500 & 590 Silicone Under the Muscle?

I am having implants with a lift in 4 days! I am 5'10" and 145 lbs. I had two consultations and one doctor suggested 590cc which sounded huge. However when I had a second opinion with a doctor who is well known for his conservative approach he suggested 500 cc to balance out my body. When I tried in the spacers with my clothes on, the 600cc looked like I normally look in a push up bra. I don't want to need a push up after my BA. Do you think the result can be accurately predicted by the spacers?

Doctor Answers 10

Sizers and Accuracy in Breast Augmentation

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   Sizing someone for breast implants can be somewhat inaccurate, because the implants are blunted to a degree if they are placed under the muscle.  I tell patients to add about 50 cc to whatever size they select.  Also, remember that the profile of the implant and the chest wall width as well as volume will all need to be reconciled.

Best Breast Implant Size/Profile for Me?

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Thank you for the question.
 As you can imagine, despite your good description of body type and goals, it is not possible to give you precise  advice online.
The best online advice I can give to ladies who are considering breast augmentation surgery 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're 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 “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.

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.

I hope this helps.

Implant size selection to acheive your goals

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There are many factors that go into implant size selection.  I consider two factors when selecting implants for my patients:

1.Dimensional planning
2.Gel Implant Sizing system
Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.
Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.  If you have decided on saline implants, then based on the gel sizer you select, we can guide you to the saline implant that achieves a similar look.
Hope this helps.
Dr. Basu
Houston, TX

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Breast implant size

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Both sizes you mention are pretty large, so if you are undecided between the two, I recommend the 500 .  Believe me, it's plenty!

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The "baggy test" or using spacers gives a rought estimate for the volume that may be suited for you. To be more accurate, you would need an exam.

Steven Wallach, MD
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Breast Implant volume anxiety

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At 5'10" and 145 pounds an implant in the range of 500 to 600 may be very appropriate or it may be too large.  There are many factors to consider when selecting an implant for breast augmentation.  Unfortunately all the patient usually looks at is volume.  This is actually the last thing that I look at.  It is imperative that the implant to be used has been properly sized in regards to base diameter and projection as well as your individual anatomy.   Vectra 3 D imaging is a great way to tell if you are selecting an implant in the appropriate range.  Way to often I see women who have been overly stretched out by implants that were too wide for their frame.  Using sizing implants can help get you in the ball park when it comes to size but the implant will always look better once placed.   Use your judgement and the advice of your plastic surgeon and it is likely that you will get the result that you desire.  

Jeffrey Zwiren, MD
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Choosing Implant Size

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Many patients find the process of deciding their implant size to be exciting, but also somewhat anxiety provoking. This is normal. Trying on implant sizers in a bra is a good starting point. From there either a 3D imaging system (when appropriate), or using measurements will help refine the implant choice.

In our experience, when women have a lift, the breast appears smaller after surgery even though only a little skin is removed. The true volume of the breast does not appreciably change, but visually since the breast does not hang as much it looks smaller. Take this into consideration as well.

Please discuss your concerns with your surgeon before the scheduled surgery. You need to be confident with your decision- it is your body.

Good luck

Lawrence Iteld, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

Estimating implant size

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Trying on spacers over your clothes is simply a way to figure out how big you would like to be, but not accurate in determining exact implant size. In other words, it helps to show your surgeon how large you would like to be, but the 600 cc spacer does not mean you need a 600 cc implant. Think about it- you are putting a spacer on top of your breast, while the implant is often placed under the muscle, and obviously would not offer the same shape as sitting on top of your breast. There are factors your surgeon needs to account for in choosing the best implant size for you, and these include: how much larger you want to be, the width of your chest frame, the diameter of each breast, the shape of your chest (if your breastbone is flat or sticks out more or less than your ribs), whether or not you need a lift, the quality of your skin, the amount of breast tissue you already have, etc. It's not as easy as trying on external spacers, so your surgeon's judgement is a big factor in your surgery's success. It is critical you communicate what your goals are, so that your surgeon understands what you want to achieve. If it's hard for you to describe, bring in photos of breasts you like in terms of shape and size. It's much better to sort all of this out before surgery, so don't rush if you are unsure. Also, make sure you go to a surgeon certified by the American Board of Plastic Surgery.

Anita Patel, MD, FACS
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Breast Augmentation Size

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The choice of an appropriate size is a critical component of any breast augmentation. I utilize both computer imaging and sizers to indicate the range of potential results. There is not anything that with total accuracy predicts the final result.There are a number of reasons for this and they pertain to both the implant type and size in addition to the patients preoperative anatomy.

Breast Implant sizes

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It sounds like you have doubts regarding your breast surgery.  You need to have all your questions answered by your surgeon, and feel comfortable with him before taking this surgery journey with him.  It would be wise to discuss the surgery again with your surgeon prior to your surgery even if that means rescheduling the procedure.

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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.