Wondering if I can handle 550 cc HP silicone? Or 600 UHP? Or should I stick to 500 HP? (Photo)

Question

I got a breast augmentation 7 years ago. 250cc, under, silicone, round, moderate. I am 117 lbs. 5'4. I am on the lighter side. I am typically 125 lbs. I am a 34B. But since I started lifting pecs every other day I've moved up btw b and c cup. Currently wearing a c. I started as a 34small a. I would like to have breast that can be pushed up to make cleavage. I am unable to do that w a bra. I usually tape them together or put multiple socks in the bra. Should I use HP or UHP. Wat size is too big?

Daniel Barrett, MD · Answer

Dear blonddavelover,Many women seek improved cleavage. Narrowing the cleavage plane can be done very carefully by a skilled surgeon. Moving the implants too far medially can result in synmastia or unaboob which is very difficult to correct. That being said, the right amount of pocket dissection and implant selection can create excellent cleavage. Regarding the implant size, determining the ideal breast size and matching that goal for the patient is the most difficult part of breast augmentation. It starts and ends with the patient. 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 its 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, everyone of them have 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.Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery
Member, Am. Society of Plastic Surgery

Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Austin Hayes, MD · Answer

Ask your surgeon what size implants they recommend. I would also speak with them about their thoughts on  frequently lifting pecs. Implants placed under the muscle move down and to the outside with contraction of the pectoralis muscle. Although it's okay to do any activity that you like with implants under the muscle, frequent chest exercises may push your implants into the wrong position or stretch out the skin on the bottom of your breast. If you're doing pec exercises to work other muscles, then you might consider just lifting those other muscles and not your chest. For example doing tricep pulls instead of benchpress. Modifying your lifting routine can help your results last longer.

Shlomo Widder, MD · Answer

Dear Blond,   Thanks for submitting your pictures and sorry for your problems. From observing your pictures, you appear to be small B cup size with wide cleavage, bottoming out and possibly, lateral displacement of implants.   Based on these findings, your corrective surgery is more complex. You do not have to go very big , in order to get nice cleavage. Just by getting inferior and lateral capsulorrhaphy(internal bra)  and medial capsulotomy (scar release) you will get very nice cleavage. Your cup size will most likely increase to B cup size with these maneuvers. To become 34 full C cup size (very attractive and natural) you will need implants with volume of 475 cc, for 34 D cup - 550 cc.    You have to realize that not all results are the same , because experience, skills and aesthetic eye are critical for good outcome. So, do your due diligence carefully and choose your surgeon wisely.  Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation, in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                        Best of luck,                                              Dr Widder

M. Scott Haydon, MD · Answer

Thanks for your question and the photos. Given your small frame, I can't imagine that your base diameter is much more than 12cm. Yes you can cheat a little, but the size and volumes you are considering are an inch wider. If the pocket is made large enough to accommodate that implant, it will either spill out into your arm pit, or cross over to the opposite side and create symmastia. Given your athletic frame and work out schedule, that large an implant will really interfere with your pectoralis and likely give a lot of animation deformity. You also already have some bottoming out and a large, heavy implant is going to be at risk of malposition and asymmetry. I'm not trying to be negative, it's just important for you to understand the risks of going that large. Best of Luck!

Christopher V. Pelletiere, MD · Answer

Without an examination, it is hard to know exactly what will fit well with your frame.  Going up to 550cc HP may be too much width for your current dimensions and frame.  To add that much more volume you may need an UHP due to the width of the device.  As the implants get bigger they get wider.  A 550cc HP is 13.7cm wide, compared to your current implants which are around 11.5cm.  That may be too much width to accommodate without running the risk of seeing or feeling rippling over time.  I would go for a few consultations with board certified plastic surgeons and see what they recommend.

Robert Caridi, MD · Answer

You are quite petite in size. You already have some signs of bottoming out of your implants (more fullness on the lower breast and higher riding nipples). Larger implants are going to increase your chance of complications across the board big time. Why go there? 
I suggest you are at a wonderful size and that you need to love what you have and avoid disappointment with a larger size. If you had to have another procedure, I suggest a size in the mid 300 cc and high profile implants with a pocket adjustment to move them up and post operative massage for more cleavage and then an excellent bra to keep your breasts "up and in" all the time.

Tom J. Pousti, MD · Answer

Thank you for the question.  Although it is not possible to provide you with definitive advice without an person evaluation, most patients are able to "go larger" at a second stage, once the breast tissues have expanded (after first-time breast augmentation).  Sometimes, during this revisionary surgery, adjustment of the breast implant capsules is also necessary to achieve the desired outcome.

You will find that online consultants will not be able to provide you with specific advice in regards to selection of specific breast implant size/profile.

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical.

Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation 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. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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 "D or 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.

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 ( after the use of temporary intraoperative sizers). Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select the best breast implant size/profile for the specific patient.