275 cc Natural Breast Aug for Tall, Slender Frame? (Photo)

Question

I am 38 years old, 5'8", 127 lbs. I'd like to look more feminine/ less boyish in clothing; to have the fuller breasts prior to breastfeeding for 4 years. One PS measured my BWD at 11.5 and 12, recommended Mentor 300 MP or 325 HP. He emphasized that a taller woman can (should?) carry a larger implant on her frame. The other PS had my BWD at 12.3 (both) and recommended Mentor 275 MC or 300 MP. What size and profile would you recommend? Also, what should I do about differing BWD measurements?

Donald Groves, MD · Answer

Hello and thank you for your question. Honestly, a formal in-person evaluation would be needed to determine the best treatment. There are several reasons for this: 
1) Bra sizes vary based on the clothing store (for example, Victoria's Secret tends to upsize everyone by a whole cup size)
2) Most women do not wear the proper exact fitting bra size for their bodies
3) The exact volume (in cc) needed to change cup size is different for different body types (e.g. 32A to 32D requires a different implant size than 38A to 38D)
4) Be careful NOT to fall into the trap most women do- they see a certain implant size (e.g. 285 cc) or perhaps their friend had a certain size, and they want or request this or another size based on that. Everyone's body is different- 285 cc implants on your friend might look VERY different than they would on you. Be very careful not to make this mistake, because the goal is to find the right size and shape for YOU- for your particular body and your breasts.

Because of those multiple factors, and because it is KEY to fully evaluate your breasts in person to make a full set of precise measurements to select the proper implant for you (incorporating factors like amount of breast tissue, implant type, base width, projection, etc), answering your question really would need a formal personalized consultation- to say anything before that would simply be guessing, which would be both unfair and unhelpful to you. Also, just FYI, each surgeon's measurements are slightly different, so numbers, experience, and overall aesthetic from one surgeon aren't necessarily the same as those from another surgeon!

Your breasts are such a KEY area of your body and your femininity- therefore, you should ONLY trust an experienced aesthetic plastic surgeon. As such an expert, I have had extensive training and experience with complex aesthetic surgeries under a multiple world-renowned experts in the field. I’d recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with aesthetic plastic surgery procedures) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Keith Hodge, MD · Answer

Your differences in measurements are minimal and completely normal. With your height, all the sizes that you are considering are conservative, probably a C cup. If you are wanting a proportional look, I would recommend a moderate plus profile. A high profile implant will give you more upper breast volume, and may look more augmented. Hope this helps!

Joe Gryskiewicz, MD, FACS · Answer

Hi NewCans,The profile is not really that important, but what matters most is your dimensions because each company's implants have different dimensions. So this is perhaps the hardest decision for a patient
to make, as well as the surgeon. Cup size estimates can be misleading, but I
generally advise patients that they will experience an increase of
approximately one cup size per 200 cc. You can try on implants in the office by
placing them into a special bra.Approximately 50 cc (1-2 oz.) is added to the final volume to account
for flattening of the implant in the partial sub-muscular pocket. Once you
decide on a size you like, then add on about 25-50 cc, because in real life the
implant will be flattened slightly by your tissues.Multiple measurements need to be taken to fit
an implant to your exact anatomy.  Have your surgeon's office show you the
charts of the implant dimensions for the various profiles of silicone and
saline from the manufacturer.  Then you and your surgeon can piece
together the puzzle by matching your measurements, with your wishes, versus
your tissue cover and the available implants to arrive at a surgical plan.Keep in mind larger implants tend to have
more problems over the years.Since
silicone implants wrinkle less than saline implants, they might be your best
bet.You can
also approximate this at home by measuring out an equivalent amount of rice
placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and
see what you think.Implant size must
square with assessments of tissue cover, breast diameter, and chest wall width. Multiple
measurements of your chest wall are taken (seven in total). Implant size selection has been an issue of
much discussion. Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape. A photo album of patient pictures is maintained to assist them.
These photos ultimately help in determining where the implants will be placed,
since they can be shifted inside (to provide more cleavage), to the outside, up
or superiorly, and down or inferiorly during surgery. In determining the final
size selection, I always place the highest priority on the preoperative
measurements and potential tissue cover. Then, the patient’s verbal requests
are factored into the analysis.Our
average size over the last 7,000 implants was 350. We use the quick recovery approach, so click on the
web reference link below to have this explained.Be sure to see only a board certified
plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a
member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a
member of ASPS (The American Society of Plastic Surgeons). Also, ask if they
have an established, high volume breast augmentation practice, performing several
hundred breast augmentations each year. Be sure the PS has been in practice for
a while, 20-years or more might be a good gauge.Does the PS offer all three incisions?Discuss the implant type (gel or saline),
shaped "gummy bear" or non-shaped, smooth or textured, implant pocket
(over or under the muscle) and the "quick recovery approach."Ask to see their before and after photos if
you didn’t see any on their website.  If they are experienced, they should
have several 100 breast implant patients for you to view.  I would also
recommend that your doctor offer you the chance to talk to past patients who
would be happy to discuss their experience with you.  You need to feel
comfortable, so make sure the environment is safe as in an accredited surgery
center. Also, ask a prospective surgeon if he or she has ever published journal
articles in professional peer-reviewed journals, which they can provide
you.All
the best, “Dr. Joe”

Deborah Sillins, MD · Answer

I never mention size. I am an experience enough to know what would look nice for you. I use dozers at the time of surgery and put in appropriate size depending on what cup size you wish to be. I am more visual and artistic then numbers

Rian A. Maercks, MD · Answer

Your thoughts and concerns are very insightful and important.  Keep in mind that most breast augmentations look like breast augmentations.  The "augmented look" is very well tolerated in the public, on celebrities etc.  The typical breast augmentation is what the public calls "under the muscle" and doctors call "dual-plane."  Essentially the inferior and some of the lower midline attachments of the pectoralis major muscle are cut and the implant's top and central portion are under the muscle, the remainder of the implant is in a subglandular plane.  The central origination of the pectoralis major muscle assures that the implants are pushed away from midline.  The medial cleavage of natural breasts is thus not achievable and surgeons compensate by planning a "base width" of the breast several centimeters from midline.  They then compensate for the reduced width by selecting moderate and high profile implants that are narrow to fit this space.  This means that in a patient like you, your already narrowed and slightly separated form will be amplified.  Variations in base width measurement depend on how it is measured.  In my practice, I use a technique called "Cold-Subfascial Breast AugmentationR" that allows me to plan a breast augmentations according to an "ideal" basewidth instead of one constrained by the limits of the pectoralis major muscle.  Thus my measurements are likely to be 1-3cm wider than another surgeons.  My goal is to get a breast that has a soft start just next to midline and has a gently rounded shape projection just lateral of the chest wall for a beautiful natural silhouette.  This technique utilizes the strong tissue called fascia that overlies the pectoralis major muscle to not only shape the implant further but to also support the implant like an internal support bra.  The result is a softly draped feminine form free of the animation deformities and "down and out" appearance that is so common in breast augmentation.  I would strongly recommend an implant that fills the height and width of your IDEAL breast footprint, not the submuscular space.  I would most likely recommend and Allergan 410FM anatomically shaped form stable implant.  I hope this helps!All the best,Rian A. Maercks M.D.

Alexander G. Nein, MD, MS, FACS · Answer

There is no right or wrong answer as to which of these implant choices you should make. Every person is different and it is important that in the end YOU are happy with the result and the size that you are. Measurements are important to determine an appropriate starting point but in the end it is your decision as to what you like. All of the implants recommended to you can give you a very nice result with modest differences among them. I would note that for the implants my patients have chosen over the years, the ones suggested to you are at the smaller end of the spectrum.For some more information about how to choose implant size, please check out the link below.For the best results seek the consultation of a plastic
surgeon certified by the American Board of Plastic Surgery. They have a website
listing all the certified plastic surgeons. Members of the American Society of
Aesthetic Plastic Surgery will all be board certified in plastic surgery and
have demonstrated an interest and special skill in cosmetic plastic surgery as
well.

Ronald A. Lohner, MD · Answer

First of all, thank you for your thoughtful and well worded question.  I can tell you that someone who possesses your clarity and concerns is always a welcome patient in my practice.Quite simply, you are tall and can potentially carry a larger device.  However, you are thin so that large implants, especially high profile will certainly not look quite as natural.  I believe that BWD are estimates and not like going into the shoe store and having your foot measured.  I personally use sizers in the office with the prospective patients fully clothed, as that is how we most often see ourselves on a daily basis.The size differentials you were offered are relatively similar.  For someone with your frame, I would consider a NON high profile device based upon your surgeon's recommendations.  Best of luck and don't sweat 25 cc's in your decision making process here.

Kiran Polavarapu, MD · Answer

It would be really pertinent to have a full consultation with breast measurements taken. Using this information, your plastic surgeon can help you chose the appropriate implants and the " look" you are going for and advise you on other adjunctive procedures to give you your desired look. Good Luck!

Robert Singer, MD · Answer

The best cosmetic result in any
particular breast augmentation patient depends on a variety of factors,
including: your individual anatomy, realistic expectations, a thorough
discussion with the plastic surgeon about the options, and an understanding of
the pros and cons of any particular implant choice. Proper sizing is not just
about the number of cc’s. The thickness of your tissue, breast dimensions which
include the width, height, and projection, as well as chest wall width all need
to be considered when choosing an implant. Trying on implant “sizers” of
various shapes and volumes while wearing a tight t-shirt, bra, or bathing suit
at a preoperative visit will help you and your surgeon choose the optimal
implant.

Keep in mind that following the
advice from a surgeon on this or any other website who proposes to tell you
what to do without examining you, physically feeling the tissue, assessing your
desired outcome, taking a full medical history, and discussing the pros and cons
of each operative procedure would not be in your best interest. I would suggest
that your plastic surgeon be certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) that you trust and are comfortable with. You should discuss your
concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Paul J. Leahy, MD · Answer

Thank you for your question, and the photos are very helpful. First, measurement of the BWD (breast width/diameter) is very helpful in choosing an implant that will create the look you desire. An implant wider than that will provide more cleavage, but also show more on the outer aspect of the breast. An implant too narrow will not fill out the breast appropriately. However, this is not an exact measurement. Surgeons will likely vary at least 1/2 of a centimeter (5mm) making this measurement. That amount is not going to make a dramatic difference after surgery. My guess is that an implant in the 300-325cc range will give you a nice final result that is very natural in appearance. The moderate profile implant will be just barely wider and will not project as much outward from the chest compared to the high profile implants. I would encourage you to try the implants in a non-padded bra one more time before surgery. Best wishes.

275 cc Natural Breast Aug for Tall, Slender Frame? (Photo)

Answers (11)

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