Thank you for your interesting question. Two selected possibilities are very similar (size) and both are quite small (volume), but as your wife wants a "mid-full B cup", I think that 220 MODERATE PLUS is a better option.
In my experience, we have achieved maximum patient satisfaction with final result with this "step" guide:
Patient desire / choice
Clinical examination and measurements. Based on measurements, your surgeon will take photographs, on which he/she will be able to explain the different options (shapes, sizes, ..).
Biodynamic software (Natrelle-Allergan/European Union) that allows you (using different sizers in your bra) to see in a mirror the different options, clarifies most of the doubts.
eStetix / Vectra / AxisTree virtual simulation software. We use eStetix (Crisalix), but both Vectra (Canfield) or Axis Three, will help you to visualize how you will look with different breast implants.
Plastic Surgeon's advise
Moderate or moderate plus breast implants
Start by looking at before and after images on the website of a plastic surgeon you are considering. It is important to be confident that you share the same aesthetic sensibilities as your plastic surgeon.
In consultations I listen carefully to each patient to ensure that I clearly understand their goals for breast augmentation surgery. I have never understood the desire on the part of patients or physicians
(especially physicians) to create unnaturally large breasts.
Selecting the proper size and shape of an implant requires Biodimensional planning. If measurements are carefully taken during patient consultation, one can determine an ideal base diameter given a patients starting breast shape and starting chest wall width. If the base diameter is inadequate, then implants appear too far apart on the breasts, sort of lonely and separate, and it is truly an underwhelming and aesthetically unfavorable cosmetic surgery result.
Much of the final “look” achieved after breast augmentation surgery depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant.
3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may make a significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. 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 “C cup” or "fake looking" 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.
I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
My best advice is communicate clearly with your plastic surgeon and have him/her make the decision. Here is why: It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “B” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.
Probably doesnt matter until you get to high profiles, these implants will have an abrupt change on the chest wall from chest to breast which many woman end up hating long term as its a vert fake look
Picking your implant size
There are several variables in determining implant size. When recommending implant size for my patients, I consider the followings: 1) patients' anatomy (height, weight, chest width, chest height, amount of breast tissue) and 2) patients' desired look/goal. Without knowing your chest measurement and breast tissue amount, I cannot give you any recommendation. You should visit with board-certified plastic surgeon who will examine you. Try implant sizers to get a rough estimate of the size you may want. As you know, bra/cup size will vary depending on the brand. Good luck with you.
Dr. Sugene Kim
Finding the right implant
For me finding the right implant is about getting the shape right. I would reccomend that you and your wife have at least two sizing sessions where she tries on the implants you mentioned in a tight shirt and bra without padding. Is this a simple test? Yes, but it works quite well at getting the shape right. The implants seem a but smaller when they are done for real but once the shape seems right it dosent really matter what bra fits best because the look with and without clothing will be right. We do this on all our patients and as a result have a very low revision rate and almost never for size related issues. Hope that helps, Dr K
It's best to discuss your wishes with your trusted surgeon to determine if the slighly larger moderate plus profile or less projecting moderate profile is best in achieving your goals. The difference is minimal, however review your desires with your surgeon to be a full B cup to determine the appropriate implant.
Dr. Pedy Ganchi/ Village Plastic Surgery
Ridgewood, New Jersey
The best way for you to determine what implant volume may be acceptable for you is by doing a baggy test or placing sizers in a bra.
These implants are close enough in size that I don't imagine that much of a difference in any event.
I personally prefer the shape of the moderate plus. However, if you ask me what is beautiful, you do not know if I think Picasso produces more beautiful work then Michaelangelo.
The overriiding decision is to produce a result, you will appreciate. Your wife's comment about wamting to look natural tells me that your wife mict apprei