I'm 5'6, 130 lbs, 34A after breastfeeding; what placement, size & incision would you recommend to achieve a D cup? (photos)

I am a 5ft 6", 130lb, 34 year old mother of 2 breastfed children with 34a breasts and the desire to increase to a very natural looking 34d. My sternal notch to nipple distance is 21 centimetres on the right and 22 centimetres on the left. My breasts are 15centimeter in diameter. My PS has advised sub glandular breast augmentation or sub muscular with a nipple lift and I am struggling to make the decision. What you would recommend in terms of placement, incision and size? Thanks in advance

Doctor Answers 9

Breast implants and cup size

If you want silicone implants it looks like you have small areola and you might be better off with an inframammary fold incision. I prefer under the muscle as opposed to over the muscle.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Implants for a D cup after pregnancy

Based on your photos you should be able to have a biplanar breast augmentation under the muscle which has many advantages over subglandular.

If you want nipple symmetry a small periareolar lift on the lower side will be required but maybe not on the higher side.

A rough estimate is 200cc/cup size thus to go from A to D would require breast implants in the 350-400cc range


Looking at your photos, you have minimal glandular tissue that would cover a subglandular implant.  This would lead to the implant easily being seen and felt.  Given that your nipple is well above you IMF a submuscular implant would give a great result.  A lift is not needed.  I also doubt that a "natural D" is really achievable in you.  Make an appointment with a board certified plastic surgeon to get a full evaluation.  Good Luck!

Adam Saad, MD
Atlantic City Plastic Surgeon
5.0 out of 5 stars 4 reviews

I'm 5'6, 130 lbs, 34A after breastfeeding; what placement, size & incision would you recommend to achieve a D cup?

Thank you for the question and pictures. Base on your photographs, you are starting at a great place and should have a very nice outcome with breast augmentation surgery. Based on the photos, I do not think breast lifting is indicated. I would recommend breast implants placed in the sub muscular (dual plane) position.  

Despite good intentions, online consultants will not be able to provide you with  meaningful specific advice to be reallyhelpful.  Ultimately, in person consultation with well experienced board-certified plastic surgeons will be necessary. Careful measurements, dimensional planning, and careful communication will be key.

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're 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 which operation and/or 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 "full look" or "fake" or "C or D cup" 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.  The use of computer imaging may be very helpful during this communication phase.

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.

I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Sizing question

Looking at these photos, and reading your height and weight, I would question the measurement of the breast diameter, and therefore any thoughts of implants as large as you might need to get to a D cup size. 

I doubt that a D cup would look natural on your frame in any setting, and a lift would probably be needed, and many surgeons would recommend a two stage procedure if large implants are used. 

I would start with a second opinion. I would not recommend subglandular positioning. For 3 cup size increase you may need something in the 450 cc and up range. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Lift with implants alone

While your breasts are moderately sagging you may be able to get away with implants alone. The best breast implants to use should have a more cohesive texture, such as the Allergan Inspira Truform 2. These implants are slightly firmer but still feel natural. Also, choose something with a more narrow base width to increase projection.

Please see an experienced board certified plastic surgeon to find out whether you are a suitable candidate. Best of luck.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Incisions, size

All of these issues depend on your goals and their relative benefits and tradeoffs. In general I would recommend placing the implant underneath the muscle for better coverage and long term results. Silicone will be a softer, more natural result than saline. The nipple lift I am assuming would be a left sided crescent lift for symmetry? I would make the incision in the inframammary fold as you have tight lower poles, small areolas and this will give the most versatility surgically.

I would try not to focus on a cup size for your result, as this is wildly different from store to store and even between individuals. Instead try on a range of sizes your surgeon recommends (likely 400-500 ml for your height/bwd as a starting point) and see if one of them gives you the look and proportions you are going for.

Zach Barnes, MD
Bakersfield Physician
5.0 out of 5 stars 23 reviews


Than you for the question, Silicone implants are approved for woman above the age of 22. If the size is chosen based on the individuals tissue characteristics the chance of having a great long term success is high!

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 76 reviews

Recommendations for 34D

You have very little breast tissue so you should not place implants in the subglandular position otherwise they will look like two un-natural balls on your chest.  It is not necessary to do any kind of a lift with only a 1 cm difference in nipple position.  Proper placement of the implant will even the look after surgery.  Doing a lift for 1 cm areolar difference is un-necessary scarring.  Since you do not have much projection and your areolas are quite small for someone who has breast fed I would recommend 500 cc HP smooth silicone placed via the inframammary approach.  You should try on the Mentor implant sizing system before surgery to gauge and narrow the volume size so you will not be disappointed after surgery. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 92 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.