Are 405 or 445 cc implants the better choice for me? Will going over the muscle accelerate sagging? (photos)

Thank you for your question. It sounds like you are down to choosing two implants that are similar in size, and your surgeon will be the best source of advice whether to go a little bigger or smaller. In addition to your goals for the final size, they need to consider anatomical factors like your breast dimensions, skin tone, and tissue thickness, which are all measured in person. Photographs can't provide the same information. Breast sagging can occur whether implants are inserted in front or behind the muscle but the outcome looks different ("snoopy nose" vs "ball in sock" appearance).

The difference in the size of the implants you are considering is not significant and one may simply fit the space better than the other. I use sizers during surgery to help my patients achieve their desired look. As for sagging, the heavier the implant, the more it can contribute to sagging. Having the implant placed under the muscle can help by supporting the implant somewhat, taking some of the weight burden off of the skin envelope.

Dear Tough332388,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery