I'm in a mental panic. I'm a very active mom of 5, health instruction who's lost 160 & needs help w/ size.Any suggestion?(photo)

I'm scheduled for surgery October 18 and I keep going back-and-forth between 200 cc and 250 cc. I know there's not a big difference but I do not want to go big I just want more volume. I've nursed all 5 kids including twins, I have lost 160 lbs. My breasts are all skin. I've been a bra size F to a B. I'm 5'7". 137 lbs wanting to go to a full C. I'm currently wearing a 36c but the cup is just full of lose skin. My doctor recommended 250cc to 300cc. Help!!

Doctor Answers 12

Picking your implant size shouldn't cause a panic attack!

In the end, the final decision between 200 cc and 250 cc (or 300 cc) is going to boil down to what you like personally.  You will have to make the final choice on that one, because based upon the information and pictures you have provided either size will look great on you.  You are a "tallish" girl, at 5'7", so you have some leeway to choose a larger implant and still look great, or a smaller implant and still look great.  It's hard for us here online to make specific recommendations about implant sizes without actually examining you, but I can make a few general observations that hopefully can apply to your situation and help you.

First, I see from one of your images that you are considering anatomically shaped implants.  I think that's a great idea.  I love the shaped implants, especially for slender girls with not a lot of breast tissue who specifically want a "natural" look to the breasts and want to avoid an overly rounded, unnatural upper breast contour.  The one thing that I find in my own patients when we are choosing between two sizes of shaped implants, is that more often than not, if we "cheat up" a bit and go with the larger of the two sizes, we wind up being happier.  That's because the volume in a shaped implant is distributed differently than in a round implant, and the impact of the extra volume is very subtle between two close sizes.  You are trying to decide between a 200 cc and a 250 cc implant.  That is a 50 cc difference - just shy of a "double shot" in volume ( a one ounce shot is 30 cc, so a "double" is 60 cc).  That's not a huge difference, and most of that winds up in the vertical dimension in most shaped implants, meaning that it is distributed more toward a slightly longer shape vertically, as opposed to a higher projection in the top of the breast like we would see with round implants in the same situation.

This brings me to the next point.  You have breast fed 5 children and lost a lot of weight, and you say that your breasts are deflated and "all skin."  Most ladies I meet like that have some laxity in the breast tissue, and even though your nipples appear to be well aligned and you don't need a lift, I'll bet that you have laxity of the lower breast tissues, and you might even have some "glandular ptosis," or drooping of the bottom edge of the breast gland below the inframammary fold.  Given the way that shaped implants work, the majority of the volume and projection is in the lower pole, at or even slightly below the level of the nipple.  Thus, the implant itself has the effect of pushing the nipple upward and outward, without creating a large amount of similar projection in the upper pole like round implants would.  This effect will be slightly more with a slightly larger implant, and in your case, that may be worth considering if you have the kind of laxity I have described.  Again, this is one of those considerations that a personal exam is helpful with.

Another thing to consider is that with shaped implants, much more than with round implants, we approach the planning from a "dimensional" as opposed to a "volumetric" perspective.  This means that to the surgeon planning the operation, the dimensions of the chest and breast tissue envelope and how the implants under conderation will  fit and interact with them are much more important than the actual volume of the implant.  This is still important in the case of round implants, but not nearly as important as with shaped.  Thus, you may find that your surgeon has some input into the optimal size of implant you should consider too, based upon the measurements he or she has taken of your chest and breasts, and that needs to be considered as well.  You said they recommended 250 - 300 cc, and there may be a reason for that.

Lastly, I realize that you are gauging the appearance of your breasts with each size of implant by trying on implants in your bra and looking in the mirror.  Unless you are using specially designed sizers, this may be a bit of an overestimate of the size, and more importantly the projection, of the breasts after surgery, and even if you are using sizers it still may be an overestimate depending upon how the sizers fit over your natural breast tissue.  This is because once the implants are in place in their pocket, as opposed to just sitting on top of your natural breasts and just sticking out there, especially if they are placed in a submuscular or dual plane position, they will not project as much as what you are  seeing now.  

The good news is that you will look great no matter which size you pick!  The bad news is that you have to pick, but hopefully we will give you enough information that you can add that to your consideration and come up with an educated choice.  I can tell you just for perspective that in my own practice, especially with the shaped implants, the average size we use is in the mid-300's, so at 200 - 250 cc on a 5'7" frame, you are not going huge by any stretch of the imagination.  Just keep thinking about it, ask yourself if you would be more disappointed if you were too big or too small after surgery, and lean on your surgeon and his or her staff to answer any specific questions you have left before surgery.  Try not to worry too much about this though, I think the hard part has been done, and you'll look great with either size! Best of luck.

All Are Good Options

The goal of mastopexy (breast lift) augmentation is to create an aesthetic breast with the size, shape, and projection that is desired by the patient. During a consultation, measurements of the breasts are used as a starting point to recommend a breast implant.  

The decision on size, shape, and position of these implants is based on your anatomy, the type and size of the implant, and your preferences. The type of lift is determined by your current nipple position and the quality of your tisssue.

As you consider a size, from your photos, a 200ml, 250ml, or 300ml  implant would likely both be proportionate for your frame. That being said, when deciding between similar sizes, I usually council patients to narrow it to two and then choose the larger size; it is a rare patient that wishes they were smaller once the breasts have settled and they get used to them.

See the link below for more info on breast augmentation and breast lifts.

A detailed examination will help delineate the best surgical treatment. In office sizing and digital three-dimensional simulations can help guide your implant choices. A second opinion with a plastic surgeon certified by the American Board of Plastic Surgery would be the next best step.

Breast augmentation

Thank you for your question and photographs.

From what you have stated, it seems as though you are more worried about going “too big” than “too small”. This leads me to believe that you may be happier going with the smaller size. There isn’t a huge difference between the two implants and either would like proportional on your frame. Your doctor will give you recommendations but it really comes down to your decision and what you feel most comfortable with. Best of luck.
Sincerely,

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 68 reviews

Implant size choice is difficult

When considering breast enhancement surgery there are many variables to be considered that can only be properly evaluated after an in depth consultation with measurements, photographs and a detailed history and physical.  The final surgical decision is based on the patient's desires, skin envelope, current breast size, scars, recovery period, plastic surgeon's experience, etc.  The hardest decision is choosing the proper size breast implant, without the above stated consultation it is hard to give you accurate information.  However, you are considering VERY SMALL implants, less than 1% of  breast implant patients choose 200 cc implants.  You are almost better off just buying a padded bra and saving $5,000!!!   I would vote for the larger size, as the most common complaint, by far, after implant surgery is that the women wished they had chosen a LARGER SIZE.  Go with the 250 cc implant.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 73 reviews

Best breast implants for me?

Congratulations on your very significant weight loss (and on having completed pregnancies)! Online consultants will not be able to provide you with specific enough advice to be truly helpful. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical. 



***Given your concerns, I would suggest that you schedule additional time to spend with your plastic surgeon communicating your goals, preferably prior to the date of surgery.



Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) 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 are 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. For example, I have found that the use of words such as  “natural” or "full C 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.  Again, the use of computer imaging has been very helpful during the communication process, in our practice.



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,  after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to  patients who have experienced significant weight loss) helps. Best wishes.

I'm in a mental panic. I'm a very active mom of 5, health instruction who's lost 160 & needs help w/ size.Any suggestion?

Breast implant size is determined by a measurement of the base width of your breast.  If your surgeon recommends 250-300 based on this measurement then I would recommend you at least code 250 cc.  This is not an extremely large size and is usually what I recommend the patient's want to look normal but not too large.  It is important to have your implant placed under the muscle and if you have nipple position below the fold on her breast and he may need a lift as well.  For more breast implant sizing please read the link below:

When torn between implant size

my recommendation is ALWAYS to go with the larger one.  As may have been mentioned, the most common complaint I get is 'I wish I went larger', hand down.  50 cc's is not a huge amount when considering your height.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Sizing

Hello,

You're doing the right thing; sizing in the mirror. Stop thinking about bra sizes. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Breast augmentation and massive weight loss

Congratulations on your weight loss. Without a full examination and certain measurements of the breast it is difficult to answer the question precisely. However, as a general principle, if you trust your surgeon and his or her experience, then ultimately the decision should be a mutual one that may ultimately be the surgeon's discretion if you are on the fence regarding size. I would ask your surgeon about this inquiry.

Best wishes,

Dr. Ravi Somayazula

Ravi Somayazula, DO
Sugar Land Plastic Surgeon
4.8 out of 5 stars 53 reviews

Breast Augmentation - Size Selection

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. 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 breast surgery. Hope this helps and good luck with your surgery.

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.