Which size of implant would deliver natural results with upper pole volume? (photos)

Question

I am 5'5, 145lbs. My bwd is 15cm. Sternum to nipple is 21. I wear medium/large tops, 36 bra band. The PS gave me the options of allergan 375cc mod, mentor 370mod+ and m430modhigh. I have very mild pectus excavatum, located higher up, under my collar bones. Which would provide a natural outcome with some upper pole volume?

William Andrade, MD · Answer

Hello, I find that every patient has a different idea of what looks natural, so it is hard to predict this type of outcome.  I find it more helpful to base the implant selection on the person's measurements, tissue thickness, and goals that are refined by looking at before/after pics, 3D imaging, or trying on sizers.  I typically recommend implants that are a little smaller than the measured BW but every surgeon has their own system.  Your surgeon will be the best source of advice since they presumably did a detailed breast assessment.

Michal Brichacek, MD · Answer

Natural is a very subjective term. What is natural to one patient, can be too small for one patient, or too dramatic to another. I find that the 3D simulation using the Crisalix simulation software gives you the best idea of the final. It is a simulation and is not completely accurate however.
Looking at your photos, I feel like all of those implant choices would be very reasonable if you aren't looking for anything overly dramatic. The difference between all those implants isn't that large.

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 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 is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Michele A. Shermak, MD · Answer

Sizing is a really important step in the breast augmentation consult process. Measures of chest width and goal fullness size are taken into account to choose the most appropriate implant. I size by placing implants that match those I would place in a bra on each patient. Some plastic surgeons use computer imaging. Your best choice for implant should be made with your plastic surgeon. And you should understand your outcome with whichever implant is chosen.
Best of luck to you!

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. Volume (300 versus 400), 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. A 375 Moderate Plus 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 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.

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.

Daniel Barrett, MD · Answer

Dear Kaycee204,
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

Derek Fletcher, MD · Answer

Unfortunately, I can't tell you which implant is best suited for your body and goals without seeing you in person, performing a detailed exam, and assessing goal photos with you.
To ensure that I achieve my patient's goals in surgery, I request that they bring before and after photos of patients with similar frame size, starting breast size and the results they find most desirable. I use 3D imaging to narrow down the implant volume range. I perform a very detailed exam noting pec muscle morphology, rib projection, skin type, breast tissue type, and take 6 different measurements of each breast. On the day of surgery, I have 8 different implant sizes in two different projections (moderate and full for example). I use the patient's goal photos and implant sizers to ensure I create the desired change before choosing the final implant.

Connie Hiers, MD, FACS · Answer

I would suggest going back to your surgeon and actually trying on all three sizes to see what you really like. Just based on your numbers, I would go with the smallest choice.  However, what I would like and what you want may be two different things. Try the sizers on to be sure.

Camille Cash, MD · Answer

The higher profile implants will give you more upper pole fullness, however a smaller implant will look more natural.  Many surgeons have sample implants available that you can "try on" to see how you may look after surgery.  This might help you in your decision.

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