What type and size of breast implant should I get? (photo)

What type and size of breast implant should I get? Do I need to get a breast lift with my implants? My goal is to have similar looking symmetrical breast. I would like them to be higher and a little bit bigger. Symmetry and a youthful appearance are my main objective. I have had several consults but given different suggestions. I am not sure what is best for me. I am 5'9 and I weigh 197 lbs. I have broad shoulders and wide hips. My breasts have deflated after having children. I plan to have breast augmentation soon.

Doctor Answers 71

Breast Lift and Augmentation

An increasingly attractive and popular option for breast enhancement, particularly in women who have been through pregnancy and lactation, is the combination of a vertical mastopexy (breast lift) with breast augmentation. This is the ideal breast surgery procedure for women seeking breast enhancement who have experienced breast volume 'deflation' following pregnancy and lactation (and for those with 'deflated' appearing breasts who have never been pregnant), and who have the desire for a fuller breast profile.

For some patients with a significant amount of existing breast tissue, a breast lift alone may produce an acceptable breast appearance. However, it is difficult to achieve fullness in the upper poles (the cleavage area) of the breasts by means of a breast lift alone. In consultations I ask patients how important it is for them to have the appearance of some fullness in the upper part of the breasts, and thereby achieve a significantly more youthful breast profile. For patients that indicate that this is important to them, I recommend a breast augmentation mastopexy.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Breast lift + implant required for symmetry but augmentation alone will give good result

A breast augmentation with a breast implant combined with a breast lift will be required to achieve symmetry.

However, your breast ptosis or sag is so minor that ypou could achieve a nice result--but not symmetry--with a breast augmentation alone. The benefit of course is that you will avoid the scars caused by a breast lift or dermal mastopexy, which are substantial.

If you decide to have a breast augmentation with breast implant alone be sure to discuss with your surgeon the possibility of a transareolar incision (see pic below) and a subglandular (as opposed to a submuscular) breast implant.

Attempting a submuscular implant in a ptotic or sagging breast can often cause a "snoopy defrormity" in which the implant is too high and pushes the sagging breast down.

See before and after photos of breast lift with implant and transareolar breast augmentation scar.

Breast Implant Size

 Yes, it looks like you may need a lift.

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.



Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast lift with augmenation- breast implants

you have lost breast volume and have breast ptosis. Altough breast augmentation with breast implants will help to replenish your lost breast volume, you would also need a breast lift. Unfortunately, from your pictures, without an examination it is not possible to tell you what type of breast lift you will need.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Breast Lift and Asymmetric Breasts

Hi Kim,

You are correct to emphasize the asymmetry. The implant can improve symmetry if your surgeon uses different volume for either side. Lift improves the contour, shape and location of nipple. Implant gives you more fullness in the upper pole of the breast and also give you a fuller cleavage.

Hope this was helpful

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 195 reviews

Breast implants and lifting

In some respects you don't have an easy starting point. First of all, you need an implant to add volume. However at your height and weight, a proper implant will be wide enough and have enough volume that it won't make you just "a little bigger." Rather, it will add probably 2 cup sizes. If you go with too narrow an implant, with the wide separation you already have between your breasts, you will wind up looking like two tennis balls with a mile in between. The implants should be the same size as each other and the lift will elevate the nipples and tighten the skin. Make sure you go to an experienced plastic surgeon!

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Asymmetry - Voice of polite dissent

Your breasts are asymmetrical with your left being larger than your right.  You didn't include a lateral photograph which is the best way to assess breast ptosis (droop) and I would love to see that image before making a recommendation. 

At first glance, without the lateral view, you breast show a minimal degree of ptosis - typically what is classified as a 1 or 1a.  In your case, I might perform a dual plane breast augmentation with a moderate plus implant.  The size of which would be determined by your desires and breast measurements. 

You need to have an examination and discussion

This is the most common question I get in my office and the answer is simple. It depends on you. I divide the patients into 3 categories. 
1. Patient who only need implants. For these patients, the easiest way to determine what they want is based on a "wish pic." Try to find a picture of someone who has a similar body to you beforehand. Discussions about cup size or how natural or unnatural rarely help. I even had a patient tell me she wants completely natural breast in the C cup range just like Pamela Anderson.
2. Patients who can have a lift or just an implant. I have found 50% want the former and 50% want the latter. Their nipples may sit at or just above the inframammary fold. For the ones that want a lift, they usually specifically say they want their nipples to be higher and the whole breast to sit higher on their chests. For the one who only want an implant, they usually don't care about the nipple position and prefer to have large implants without the extra scars from a lift. These patients may be little saggy but their wish pictures are also someone who is a little saggy and they like the "natural" appearance of tear-dropped shaped breasts. 
3. Patients who need a lift. Their nipples may be below the inframammary fold or pointing down. Usually these patients also need an implant.

Since you fall into the second category, you need to decided whether you want a lift or just implant but if you decided on implants only, makes sure they are high or ultrahigh profile. 

Jacob Freiman, MD, FACS
Miami Plastic Surgeon
4.5 out of 5 stars 268 reviews

Choosing breast implants, Connecticut

Your dilemma is a common one and one that is easily solved with the right information. This is one reason I use the VECTRA 3D imaging system. With this tool, I can discuss patients options and alleviate much of these anxieties. Being able to view the implant and get a close idea how a implants size and projection will look on your body, is one of the most helpful aspects of a consultation, however, is only one part of the process. You would need a through examination to determine what type and size implants would be best. It would be virtually impossible for a surgeon to suggest an implant based on a photo alone.

Alfred Sofer, MD, FACS
Fairfield Plastic Surgeon
4.9 out of 5 stars 24 reviews

Breast lift with an implant

It looks like you're an excellent candidate for a lift and augmentation with silicone implants. I would place the scars around the areoalas and use about 200-300cc implants depending on how large you want to be. Talk with several plastic surgeons around your area to see what they would recommend and to see who you feel comfortable with. Good luck!

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 202 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.