Will 640cc be too big for me? I’m 5’4, 145lbs. (photos)

Hi and thank you for your photos and questions.  While choosing the right sized implant for each individual is a detailed and specifically tailored process, just from looking at your preop photos, I do not think your own breast skin and breast tissues will support such a large implant.  They may look good initially but eventually will likely bottom out because your tissues will not be able to support it.  You can see from your preop pictures that your implants are already weighing down your breasts.  A revision mastopexy with perhaps a slightly different/slightly larger implant should give you a lovely and more importantly durable result.  Best of luck!

More upper pole fullness can be achieved using several different strategies including larger/wider implants, a more cohesive silicone (gummy bear-type) gel in a silicone implant, or overfilling a saline implant.  Whether the 640 cc implant your surgeon recommended for you would be appropriate would depend on your measurements and the size of your current implants.  Yes, a 640 cc implant is a large implant, but your wish photo is also consistent with a large implant, so that recommendation may achieve your goals.  A word of caution, however, is that large breast implants cause strain on the natural breast tissues and may thin your skin and settle more over time than a smaller implant.  Your wish may be achieved in the short-term and cause problems in the long-term.

Dear  MOM.BOD.BE.GONE,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

Thank you for the question and pictures.   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 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” or "too big" 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.
I hope this helps. Best wishes.

Hello,
That would likely be too large, and, more importantly, too heavy of an implant for your tissues.  As you stated, your current implant has already been descending with time.  This is likely because your tissues are not able to resist the stretch from the weight of the implant.  Increasing the size of the implant without reinforcing the support for the implant will only lead to the same problem.  Implant support and possibly pocket selection will need to be addressed.  Good luck.
ABPS board certified plastic surgeon  

Thanks for writing, Implant sizing is based on many thing to include the base width of your breast. This a personal discussion you should have with your Board Certified Plastic surgeon. Sometime bigger is not better. There are implants that offer what you want without that volume. Don’t forget you are adding 2 1/2 pounds of weight to each side of your chest constantly pulling your shoulders forward. Back pain, neck pain, shoulder pain are some of the reason why woman get breast reductions, you are asking for that extra weight. The other thing to remember  is, ‘The bigger the implant the bigger the problem’. Have a very through, complete discussion with your plastic surgeon. You can also get second opinions. Good Luck Stephen M. Davis, MD, FACS
Certified: American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery
Member: American Society of Plastic Surgeons
Member: RealSelf Hall of Fame

Thanks for your question about breast augmentation and breast lift.  It would seem that 640 cc would be extremely large on your frame, but that is not easy to say for sure without an examination.  Seek more than one opinion if your first recommendations don't make sense to you or give you pause.  On the other hand, if you have great communication and trust with your board certified plastic surgeon stick with them and discuss in more detail.Best wishes