How Many CCs to Achieve a Size D?

Question

I am 26 have breastfed 2 kids, 5'6", 135lbs, 34B, width of each boob is 7",sternal notch to nipple rt. side 20", left side 20.25". I want to get a nice, more so natural look, no big rounded balls on my chest:) Basically I'd like to know what size is biggest I can do to achieve my goal of not looking fake but still having a nice size. I'd like to go up 2 sizes. The one PA I went to said 350 filled to 375 for big C/small D or 375 filled to 425 for nice D. But I'd like others opinions.

George Marosan, MD · Answer

Thank you for the photos and measurements. As the other plastic surgeons already stated, a cup size is between 150-250cc depending on your height and breast base measurement as the main parameters. From a 34B to a 34D you need to go up two sizes (300-500cc). To pick a size that fits you best, you need to go in for a consultation with a plastic surgeon or go back to the one you saw and discuss sizes. In my office we use sizers during the consultation to give the patients an idea what they can expect. Also, if you are not sure between two sizes, pick the larger one (still within your measurements). No one came back to request smaller implants, but at times they wished they picked a larger size.

Larry S. Nichter, MD, MS, FACS · Answer

Rule of thumb estimations do not always work out the way you may wish. 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 350 cc implant to make her go from a “B” cup to a “D” 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 link below.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question. In general, implant size does not correlate with bra cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance.  Your options would certainly be breast augmentation with implants or fat grafting. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory (e.g, implant type, incision, placement, lift, etc). I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. sizers may also help assist you with size. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Hope me that this helps! Best wishes for a wonderful result!

Richard H. Tholen, MD, FACS · Answer

Fortunately, you sent photographs and height/weight information (thank you!) which helps me make some accurate recommendations.

	First, your nipples are above crease level, so you do not need any kind of breast lift, particularly as you are seeking a size that will adequately fill your breast volume and existing skin "brassiere." However, I would not recommend saline implants, as they can not only feel less natural and show rippling in some positions, but they can also deflate and require re-operation for implant replacement. I recommend the latest generation of cohesive silicone gel implants, which cannot deflate, leak, or rupture, feel much more natural and homogeneous with your own breast tissue, and are only slightly more expensive.

	For a woman of your height, I believe you will require closer to 500cc implants to go up two cup sizes. In this range I believe that 250cc is roughly equal to one cup size. (If 150cc = 1 cup size, 450cc = 3 cup sizes, and a woman with no breast tissue of her own with 450cc per side will NOT be  D-cup.) See the link below for an example in one of my own patients. The implant profile will depend on the final volume choice after discussion with the patient (you), and the measurement of your breast base. The volume recommendations you have already received are not off by much, I just think they might be a bit small for the final result you are asking for.

C. Bob Basu, MD, MPH, FACS · Answer

It is very difficult to predict what cup size you will be after your procedure.  Cup sizes are not standardized.  So a D cup in one designer could be a C cup or B cup in another designer.   This is the approach I use to help guide my patients with their implant size selection:

	I consider two factors when selecting implants for my patients:

	1.Dimensional planning
	2.Gel Implant Sizing system

	Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

	Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.  If you have decided on saline implants, then based on the gel sizer you select, we can guide you to the saline implant that achieves a similar look.
	Hope this helps.
	Dr. Basu
	Houston, TX

Tom J. Pousti, MD · Answer

The more breast surgery I do the more I realize that there is no correlation between the size of implant and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saiine/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 

	It will be very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; 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 press 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 &ldquo;I wish I was bigger&rdquo;.

	 I hope this helps.

Peter E. Johnson, MD · Answer

Of course we cannot know for certain just what implant will give you the cup you are looking for. If we were to choose between the 350cc, or the 375-400cc., our experience would suggest the latter, and also a moderate profile implant.

	Best of luck,

	peterejohnsonmd

Darryl J. Blinski, MD · Answer

Based upon your so kindly posted photos, I recommend 400 to 500 cc's HP implant range. Best to have multiple in person evaluations. From MIAMI

George J. Beraka, MD (retired) · Answer

1) How to pick breast implant sizes?  My guess is 300 to 350 cc range. But read below.

	2) It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.

	3) Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.

	4) Then your surgeon has to tell you if your chosen look is realistic for your anatomy. The most common mistake is to go too big.

	5) I recommend that the surgeon NOT make a final implant choice in advance, because this is just an educated guess.

	6) The surgeon should have a large inventory of different size and shape implants available in the operating room.

	7) Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.

	8) Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating room inventory, and put in your breasts to complete the operation.

Leonard Hochstein, MD - Account Suspended · Answer

The first recomendation I have for you is to use silicone as the larger implants will have rippling issues. The minimal size to get you to a D is the 375. This will be a smaller D. For a mid size I would go with 450 and use a rule of thumb that 150 cc is equal to one cup size.

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