Advice Please - Don't Want to Be Too Big!

Hi! I have scheduled breast augmentation for next month. I am 42, 3 children breastfed, 36A-/B+, 31" ribcage, 150#(muscular size 2-4). Very conservative & modest...just want to feel proportional, burn the padded bras & feel comfortable in a swimsuit. PS is suggesting 400cc range, unders, silicone, mid range. I've been wearing sizers for a couple of weeks now & I'm guessing this puts me at a full c/small d. Getting scared that this might be too big for me!!! Please advise. Thanks! Ü

Doctor Answers 14

Choosing the Right Size Implants Is the Biggest Challenge

The question of determining the right size is the most frequent and most challenging for most breast augmentation patients.

There are many approaches to sizing:

  • Biodimensional: your surgeon can select a size for you based upon your measurements, skin laxity, and your preferences for a shape (profile) and cup size.
    • the most natural or "stealth" augmentation will use the lowest profile implant that fits the width of your natural breast
    • women who prefer more upper chest fullness may select a medium or high profile implant
    • a medium or high profile implant may be preferable for breasts with more skin laxity
    • increasing from one profile to the next will generally add about a cup size
  • Sizers: try different implant sizers at your surgeons office to get the proportion  and volume you seek
    • this will NOT tell you anything about shape, because the implant sitting on your breast in a bra drapes differently from an implant inside your breast
    • the implant looks about 10% smaller when placed inside your breast, so choose a slightly larger implant to get the same "look."
  • SIzing at home with rice:
    • choose a bra you'd like to fit
      • place dry rice kernels in a zip lock and place this into the bra you'd like to fit
      • position the zip lock under your breast toward the bottom of the bra cup
      • add or subtract rice until you get the look you like
      • bring the zip lock to your plastic surgeon to measure the volume you have chosen
  • 3-Dimensional Imaging: (if your plastic surgeon has this technology)
    • he/she can take a digital image of your body using a camera specialized for this purpose
    • show you a simulation of your results, using different size and shape implants

I hope these suggestions are helpful!

Denver Plastic Surgeon
4.6 out of 5 stars 39 reviews

Implant Selection Process

In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.
Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 86 reviews

Afraid implants will be too big or too small

In general, the biggest challenge for both the surgeon and the patient is ensuring that the communication about the specific surgery is clear and comprehensize so that the goals of each are met.  Both should have an honest discussion about all their concerns so that the expectations match as closely as possible.

It is much like online dating.  The success of the match is not only dependent on how many common points each has but the chemistry each has with one another.

Tito Vasquez, MD, FACS
Southport Plastic Surgeon
4.7 out of 5 stars 17 reviews

Breast implant sizing

The more breast surgery I do the more I realize that there is no correlation between the size of implant and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saiine/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  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 “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

Size of implants

It is very difficult to suggest what would be best for you without a formal exam.  If you have been happy with the general volume of the sizers and how they looked when wearing a blouse, then I would consider that size range.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Forget implant size and wearing sizers

There is no good way to determine  your implant size before surgery.  Your own surgeon does not know what is the right size  at the time he begins your surgery.  Take a photo of a nude woman that you would like to look like that is in proportion to your own body.  This gives your surgeon a much better idea of what you wish to achieve.  I no longer discuss size with my patients.  "Show me what you want."    

Gary H. Manchester, MD (retired)
San Diego Plastic Surgeon
5.0 out of 5 stars 1 review

HAving a hard time deciding on size of breast implants

Are you 4' %' or ^' tall? this makes adifference as well. You will be the best judge if you are going to be too big. ASk for the advice of friends and family while wearing the sizers. They may help you in the decision making process.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Advice Please - Don't Want to Be Too Big!

I can ONLY guess that 400 cc's is the best size, you did not post photos! Keep seeking in person opinions to better understand your desires. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

400 cc breast implants probably too big for you.

How to pick breast implant sizes

1) This is the most common type of question on RealSelf.

2) It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.

3) Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.

4) Then your surgeon has to tell you if your chosen look is realistic for your anatomy. The most common mistake is to go too big.

5) I recommend that the surgeon NOT make a final implant choice in advance, because this is just an educated guess.

6) The surgeon should have a large inventory of different size and shape implants available in the operating room.

7) Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.

8) Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating roon inventory, and put in your breasts to complete the operation.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Breast size

A couple of points:

Ask yourself, if you came out too big or too small, which situation would make you more unhappy.

The most natural look usually is created by the least projecting implant that fits the dimension of your native breast. This assumes an ideal contour to start with without significant sagging.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

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.