Confused on size: 430cc or 450cc? Currently have 360cc (Photo)

Thank you very much for enquire.The only type of breast implant that can be re-filled with a syringe are the saline implants (if the valve can be located) but the consistency is that of a bladder filled with water, therefore i recommend you change them for Cohesive Gel - Silicone Breast Implants with textured cover ("gummy bear implants".They are quite safe and aesthetically best as they give a firmer consistency, better projection and most natural appearance than Saline implants.Respectfully,Dr. Emmanuel Mallol Cotes.-

The gap between your breasts can be improved by dissecting the pocket of each implant medially.  This will help round out the shape in this area.  Going up to 450 cc should be fine based on your current breast ptosis and skin quality. 

you need to sit with your surgeon to have a discussion about not only the volume but the look you want. Realize that your breasts sit far apart/you have a wide sternum, which will make it nearly impossible to get your implants/breasts right next to each other. I am sure they can be closer than you have currently, but that is just your breasts and the way they sit on your chest. As for size, no reason to use saline anymore, silicone/gel feel and look much better. Changing the profile/style can give you a perkier look depending on what you have in now(likely Mod+). Any implant swap under the muscle, you need atleast 75-100cc increase to see a significant difference in size. Best of luck. 

Eva,
Great questions and congrats on staying in great shape. Your implants are bottomed out in the photo you sent. I would suggest a consultation to be certain but you likely need a pocket revision and upsize to a moderate profile silicone textured implant.  Your widened look is due to bottoming out and incomplete release of the pectoralis medially.
Daniel Barrett, MD, MHA, MSCertified, American Board of Plastic Surgery Member, Am. Society of Plastic Surgery

Hi  and thank you for the question. The size change that you were asking about is very conservative. When my patients are interested in switching to larger implants, I Typically tell them it will take between 150 and 250 cc to really notice much of a difference. One suggestion for you is to find a practice like mine that uses the Vectra 3-D imaging system. We use this software to show our patients what they would look like with different size implants. We use this both during the patients first surgery to pick implants, as well as revision surgeries when patients are trying to figure out how much larger to go. My other suggestion would be for you to consider silicone implants instead of saline.  Silicone  implants tend to be softer and give a more natural look and feel. The vast majority of patients who have had both types of implants prefer their silicone implants. Good luck to you.

Dr West

Thank you for the question and pictures. Ultimately,  careful selection of your plastic surgeon and 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. Keep in mind, as you think about options, that adjustment of the breast implant capsules may be necessary to achieve your desired outcome.





Generally speaking, the best online advice I can give to ladies who are considering revisionary 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 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. I have found that the use of words such as “natural” or "up a cup size” or "too big for my frame" etc 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. 



3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.







I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps. Best wishes.

The final choice of implant size should really be based on the measurements taken on your physical exam with your surgeon, discussion with him/her, and your goal.  That being said, a 20cc difference in size is essentially imperceptible after surgery--it's a little over a Tablespoon (i.e. not much when it comes to breast volume).  Generally speaking, most women wish they would have gone a little bigger after everything is said and done, so best bet is to choose a slightly larger implant. Good luck!

If you are OK with the slight sag than I would recommend at least 550-600 cc as the better choice.

I think that you have multiple options and depending upon your preference one might be happy simply changing to reasonably but not excessively larger cohesive silicone gel implants (I use smooth round) possibly accompanied by closure of the lower pocket with capsulorrhaphies.   If you're currently subglandular, changing to partial subpectoral will subtly make the implants seem smaller so a size increase is a good thought.  Eventually, you may need to consider a full uplift with skin reduction if your tissues stretch and thin in time from the weight of the implants.Best advice, find a Bd Certified plastic surgeon whom you trust and discuss all of the issues to your satisfaction.  Best wishes,



Jon A Perlman MD FACS 



Certified, American Board of Plastic Surgery 



Extreme Makeover Surgeon ABC TV



Best of Los Angeles Award 2015, 2016 



Beverly Hills, Ca