Breast enlargement - Would 400cc be too much? (Photos)

Question

I am 43 yrs old, mother of a 2,5 yrs old boy; 180cm, 68 kg. I would like to have silicone implants, but I dont like very big breasts; I just want to have nice small natural ones. What would the ideal ize be for me? Round or anatomical implants? I will appreciate your opinions on this. Thank you.

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.'
When sizing patients, there are .a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look.
With regards to your specific question, the ideal size is based upon your BWD. You appear to have a smaller frame, as such conservative sizing is best. In my practice, most patients select a round device.Remember..."love the look...not the cup."
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Nelson Castillo, MD · Answer

Thank you for your question and photographs.  Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing an ASPS board certified plastic surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations.  It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like.  Best wishes.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  400cc may be a reasonable size for you depending on your goals.   I recommend a smooth round silicone implant.  A round implant does not have the risk of malrotation associated with a shaped or anatomical implant.   This entire surgery
can be performed with a small incision technique.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I do this with my patients, we then look at pictures of women with similar measurements with different size breast implants. My patients tell me that this process is very helpful in determining what size breast implant is right for them. 
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Daniel Barrett, MD · Answer

Hi tonny5,

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.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

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, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

Charles Nduka, MD · Answer

The optimal breast implant size, shape and texture will depend on various factors, such as chest wall measurement, skin elasticity, your desired results, and the skill and technique of your surgeon. Breast implants of the same size will have a different appearance on two individuals as each would have a different chest wall measurements, but generally speaking, 400cc might be too much if what you are asking is natural looking, small ones. schedule an appointment with a board certified plastic surgeon for an in person examination and a detailed discussion of your desired results and the optimal surgical decision to give you great results.

Justin West, MD · Answer

Hi and thank you for the question. I think you probably could accommodate 400cc implants, but on your frame I'm not sure they would look small and natural. You might be more likely to achieve that with moderate profile implants between 275-325cc's. I would use smooth, round silicone implants. You might consider finding a practice that uses the Vectra 3D imaging system. We use this to show our patients what they would look like with a variety of implant sizes and styles. It helps give our patients the confidence that they are choosing the right implants to meet their goals. Best of luck to you.
Dr West

Sandip Jain, FRCS · Answer

Thank you for the information. Generally speaking round implant will give you a better cleavage and if you desire less fullness at the top then you can go for anatomical shape implant. Base diameter of the breast is one of the important factors which helps in arriving at the approximate implant size. 
Having said that an in person consultation and exmaintion is mandatory before making any decision re implant size, type etc.

Paul Tulley, MD, MBBS, FRCS(Plastic) · Answer

Many thanks for your question. 400cc implants are likely to give you breasts that are too large and unnatural. For small, natural breasts implants in the 210-270cc (or possibly 300cc) range, placed in the dual plane are likely to give you a far more satisfactory result. You should try both round and anatomical sizers in a trial bra to see which implant size and shape you prefer. Good luck with your treatment.

Adolfo Sesto, MD · Answer

HI. I recommend you round ones to be placed under the muscle, but 400 CC's could be too big for what you would like.International Member of the American Society of Plastic Surgeons (ASPS)
Member of the International Society of Aesthetic Plastic Surgery (ISAPS)
Member of the International Confedaration of Plastic, Reconstructive and Aesthetic Surgery (IPRAS)

Breast enlargement - Would 400cc be too much? (Photos)

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