36 DD - getting a lift and implants. Is 400 ccs going to make me look cartoonish? (Photos)

Question

Ive always have big breast. At my skinniest I was a 32 D. I am going to get a lift and implant soon and I am debating what size to get. I want to be a DD. I was thinking 400 ccs would be appropriate as when you get a lift you lose a cup size. After having kids and breast feeding I am a 36 DD. I want full breast but I dont want to look ridiculous.

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.
Based upon your photos alone, your implant choice does not sound unreasonable. However, without measurements, it is difficult/impossible to offer concrete advice. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Emre Guvercin, MD, FEBOPRAS · Answer

Hi there &mdash; this is a very common situation for women who have always had naturally fuller breasts. The key thing to understand is that a lift does not automatically make you a cup size smaller; it simply reshapes and repositions your existing tissue. The final size depends mostly on how much tissue you already have.
Since you were naturally a 32D at your smallest and are currently a 36DD, you already have plenty of volume to work with.
Do you need 400 cc to reach a DD?
Not usually.
For someone who has naturally large breasts and stretched tissue from pregnancy/breastfeeding, adding 400 cc can actually make you larger than a DD and possibly fuller than you want.
A more balanced approach
What works extremely well in patients like you is a lift + a moderate-volume implant, often in the 200–300 cc range, depending on your breast width and how much upper-pole fullness you want.
Because you already have a lot of native tissue, the implant is used only for shape, not size &mdash; especially to restore the upper pole that tends to flatten after children.
You want full but not ridiculous &mdash; here’s how we achieve that:
✔ Choose an implant that enhances shape, not overall volume✔ Use a moderate projection to avoid an overly round “augmented” look✔ Let the lift tighten and center your existing breast tissue✔ Avoid unnecessarily large implants, since they accelerate sagging again

Ted Eisenberg, DO, FACOS, FAACS · Answer

Choosing the right size and profile breast implants for you. 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

Camille Cash, MD · Answer

From the submitted photos it appears you would have a nice result from a breast lift alone.  It would improve shape, remove excess skin, and raise the nipple position.  If you are wanting to be larger, a small implant would achieve this.  The correct implant will be recommended after measurements are taken of your breasts (this is different than bra sizing) and you discuss your desired look with your surgeon.  I've included a video on this process that I hope you find helpful.

Darryl J. Blinski, MD · Answer

Based on your posted photos, one option would be to do the breast lift with an implant in the 250 cc to 350 cc range. But if you’re unsure about the implant size that IBased on your posted photos, one option would be to do the breast lift with an implant in the 250 cc to 350 cc range. But if you’re unsure about the implant size that I would separate the two surgeries doing the breast lift first waiting 4 to 6 months and then do a breast augmentation to obtain at least a 400 cc implant for result. Best of virtual console with for better understanding of risk involved. Expect fees to arrange from $6000 to $10,000 per each surgical procedure if doing in combination fees could range from eight or $9000 to $15,000 again best of virtual concert with.

36 DD - getting a lift and implants. Is 400 ccs going to make me look cartoonish? (Photos)

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