300cc or 325cc? Also with mastopexy. (photos)

Thank you for your question and photos.  When you are deciding between implants that are only 20-25cc apart, that is not a big gap to worry about.  As you mentioned, the lift is an important aspect for improving the shape of the breast.  Also, with the difference in breast size, either removing some breast tissue or using different size implants (or sometimes both) will help balance the size differences. These decisions are made with your individual surgeon prior to surgery.  
Best wishes. 

Hello, The difference in 25 cc is nominal, or nearly the same. Find a surgeon who will: 1. put in the same size implant and reduce the larger breast for symmetry and, 2. use an in office sizing system to most accurately determine what size implant to use. 

You are an excellent candidate for a lift using The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  At the same time, fat transfer can be performed on the smaller breast to match the large one or the larger breast can be reduce to match the smaller one.Best Wishes,Gary Horndeski, M.D.

Dear Easygoing1623,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation. The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   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
 

Thank you for your question.
It is difficult to suggest an exact size based on photographs alone. You may want to use 3 D imaging and morphing and / or try sizers in your surgeon's office. This coupled with your surgeon's advise should help you make a decision. 
All The Best !

With implants in the 300 to 350 cc range, you will add about 2 cups of tissue. If you do not want to be much larger, than go down in size to 200 to 250 cc's. With just the lift, excess skin, not breast tissue, is removed and you will be somewhat smaller. Going DD to larger becomes a heavy breast on your neck and shoulder especially as you age.

Thank you for the question.   
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.  Show your plastic surgeon what you mean by your goal of "D or DD cup"  using as many visual aids as possible.   As you can imagine, these terms can be interpreted differently by different people. This additional communication will go a  long way when it comes to helping alleviate your anxiety prior to proceeding.
 Some general thoughts regarding this combination procedure may be helpful to you:
 Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
Also, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars.
 
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting 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 are looking for. Ask to see lots of examples of his/her work. 
2. Again, 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 larger breasts” or "D/DD 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. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
Best wishes.
 

Hello, as you may know, it is not easy to tell the best implant size for you only by the photo and without an in-person exam. The choice depends on your self-image and your personal goals. In this case, the difference between 300-325 is not very important, and most people will not notice. The most important is which one makes you feel better. In any of both, you can have amazing results. Good luck!

The difference between 300cc and 325cc is about 3 ketchup packets and people will not be able to notice the difference. It generally takes a difference of 50cc or more before your eyes can discern a difference between the two sizes. That being said, the ideal Implant size cannot be determined by height and weight alone. It is best to have an in-office evaluation so that careful measurements can be taken to determine the best size implant for your chest diameter, several upper body measurements, and current breast tissue. Once you have the measurements, they are all put together to determine the right implant from the right manufacturer. Breast implants of the same cc's can look and feel extremely different depending on the profile and material. In my office, I have the MENTOR breast implant sizing system where different size molds are used to simulate how you appear in your own clothes and help finalize your decision. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon