Implant size: Deciding between 360cc, 375cc and 405cc - BWD 14, 5'11", 140 lb (photos)

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing. Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." Communication is key as you and your surgeon create your custom surgical plan.
Based upon your photos, your choices all seem reasonable (given the appropriate profile). I would not struggle over small volume differentials (45 ml between the largest and smallest options). 45 ml approximates the volume of a shot glass. While certainly different, most patients will struggle to differentiate between these implants (especially the smaller variations). If any of these are ultimately underwhelming or overwhelming there is the possibility the case would have been the same for all of them.
As always, discuss your concerns with a board certified plastic surgeon.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Thank you for your inquiry! During a consultation or pre-op appointment, you can bring in some different top to try on with the different sized implants. We would be happy to meet with you to discuss your options. Schedule a consultation with a Board-Certified Plastic Surgeon!

Dear txs2795,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Your goals and concerns are all questions of proportion. There is no one who is able to determine this except you. That is why in office sizing is so important. Photos of other people, whose implant size may be known, is irrelevant to you. Only going into a surgeon's office, having sizers placed into a bra, and placing a few different tops, and looking at yourself in the mirror will all these questions get answered. And by the way, although validated in scientific literature, 3D photographic morphing is poorest at allowing the patient to determine her proportions in clothing. That is why low tech sizers are so valuable.

Hi. Your frame can handle any of these sizes and all will give you a nice change. The actual size decision is difficult to make by photos. You should go back to your surgeon's office before surgery and ask to "try on" these sizes. Basically, you can put sample implants of each size in a bra and look in the mirror to see what each one looks like on you. That will help simplify your decision. Best of luck!

In your pre-op photographs, your breasts were widely separated. At this time, your breasts are somewhat lateral displaced. You will need a circumareola approach to reposition the nipple-areola complex more medial to increase the cleavage.

Best Wishes,

Gary Horndeski, M.D.

Truly any of the implants that you are considering should nicely fit your frame. Many surgeons have sample implants available that you can "try on" to help you get a feel for how you may look after surgery. This may help you make your decision. I also use sizers during surgery to help select the implant that fits best and will give my patient the result closest to her goal look.

I would suggest going back to your surgeon and actually try on the three sizes so you can see and feel how large and heavy they are. Just based on your photos, I think the 375 cc implant would do well for you.