Should I go slightly larger if going under muscle? I am 5' and weight 120. Small rib cage (28" under breast) (Photos)

10 years ago I had a 325cc LP to lift my naturally large breasts - after weight fluctuations, I now need a revision, My PS recommends a lift with 385HP unders OR 415HP if I want bigger. He emptied the saline yesterday and we tried sizers. I am looking to have definitely more fullness in upper pole - cleavage, but I do not want to look too big and busty. I just want to get back to my normal size of 30E or 32DD. I prefer the way 385 looks - but thinking that once they are under they will be too small.

Doctor Answers 1

Best breast implants for me?

Thank you for the question.  Online consultants will not be able to provide you with very specific advice regarding breast implant size and/or ultimate breast size achieved. 
 Ultimately, careful measurements, dimensional planning, and careful communication will be key.
Generally speaking, patients undergoing this 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. 
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 "DD or E cup" or "too big and busty" 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. I hope this, and the attached link, helps. Best wishes.

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.