560(R) and 520(L) full profile look too fake?

Question

I am trying to decide between 560(L) and 520(E) or 485(R) and 520(L) full profile natrelle. I am 5’ 9” 159lbs. Breast width 12.5 I want them to be big and full but still look proportional, but on the larger end. Is the 560 ans 520 implants too large for my frame. Band is a 34 but a 36 feels more comfortable to me.

Ram Kalus, MD, FACS · Answer

Thank you for your question and photos. As you undoubtedly know, a precise treatment plan or specific implant recommendation can only be determined with a careful examination and detailed discussion with your plastic surgeon. Volume (560 versus 520), is far less significant than implant width and projection. Implant width is similar to shoe size. The implant literally needs to fit into your breast and chest, as you astutely referenced your width to be 12.5 cm. The implants you suggested may well “fit” your breast, but the volume and projection are what will determine the “look” you want, similar to the style or type of shoe you would select. It is true that for a given volume a high profile implant will have a narrower diameter, and it is also true that a person such as you with a petite frame will require a narrower diameter implant than a patient with a broader chest or larger frame.  Other considerations such as saline versus silicone are also important, as are "round" versus "anatomical" or "form stable" or "shaped", smooth surface versus textured, and softer versus firmer with the different levels of gel cohesivity.

The term “natural” can mean different things to different people and the profile of the implant does not necessarily determine that. You can certainly achieve a “natural” appearing result with a high profile implant if properly selected, but as a rule, the larger the implant and the higher the profile, and certainly if the implant is positioned too high, the greater the chances you will look “augmented” because of exaggerated upper pole fullness or convexity.

In my practice, besides a thorough interview process and physical examination with careful measurements, we use on lay sizers within an unpadded bra to help you understand what you are likely to look like in a bra, bathing suit, or T-shirt with a given size implant. In addition, and this is critical, we ask all of our patients to provide us with photos of their desired final look, with images of women’s breasts that most closely resemble the look they are trying to achieve. This serves as a visual guide that thankfully rarely leads us astray. The most common reason for patient disappointment after breast augmentation is size-too big or not big enough. This algorithm which we have been employing for over thirty years has proven to be very successful.

Because all of these factors can leave you quite confused, it is crucial that you select an experienced board certified plastic surgeon whose aesthetics align with your own, and with whom you feel comfortable. Don't be reluctant to seek a second or even third opinion if necessary to be sure and feel confident about moving forward with scheduling surgery. Expressing your desired cup size is notoriously inaccurate, and final breast size is the most common reason for patient disappointment after breast augmentation, either too big or not big enough.

Take your time, do your research. Best of luck to you.

Gianfranco Frojo, MD · Answer

You definitely need a much smaller implant with a breast lift. I would also add Galaflex (for internal support for the breast). Breast implant sizing is based on your tissue based measurements. Based on these measurements (and goal), there is truly only a small range of volume that can achieve a safe, predictable outcome. You would NOT have an adequate outcome with breast implants alone. I would recommend seeing a board-certified plastic surgeon with extensive experience in aesthetic breast surgery.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size 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 is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

Augmentation alone will not be successful. Your breasts are too low on the chest wall. What is more important is a breast lift. The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

Your board certified plastic surgeon is your personal expert when selecting the right implant for you.  She/He has had the benefit of examining you and discussing your surgical goals.  From the photos submitted it appears you will need a lift along with the augmentation for the best result to address asymmetry and ptosis (sagging).

Mats Hagstrom, MD (license on probation) · Answer

It’s not appropriate for us to guide you through implant selection.
This is something you need to do with your plastic surgeon.
Different plastic surgeons have different ways of guiding patients through implant selection.
Some providers do it better than others.
My personal preference is to work with before and after pictures to get a clear understanding of what the patient is trying to achieve.
During surgery I use temporary sizers and bring wish pictures with me to the operating room.
 I use the sizes to determine what size implant will create the outcome. The patient was hoping for.
I typically have a full selection of implants available during surgery and select the implant based on the use of temporary sizers during surgery.
I found this to be the most accurate way of selecting implants, consistent with what the patient is hoping to achieve.
Using excessively large implants tends to lead to increased rates of undesirable secondary side effects, increased, complication rates, and increased rates of revision surgery.
If you have questions regarding the choice of implants that I suggest working with your current provider.
If you haven’t selected a provider, then I suggest scheduling multiple in person consultations with plastic surgeons in your community.
During each consultation, ask each provider how they guide patients through the implant selection process.
 Quality breast augmentation surgery is usually based on three variables.
The first variable is the patient candidacy for the procedure in the first place.
The second variable is the selection of implants in regards to size, shape and type.
The third variable is the surgeons ability to place the implant in the correct at atomic position.
Find the best provider, I suggest patients rely on in person, consultations and avoid virtual consultations whenever possible.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own.
And experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
 Highly experienced surgeons will in fact, have access 100 or preferably thousands of before and after pictures.
Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures they’ve actually done.
I recommend patients ask each provider What their most common reason for revision surgery is, what their revision rates are, and what their revision policy is.
 Best,
Mats Hagstrom, MD.

George Lefkovits, MD - Account Suspended · Answer

Your breasts are sagging in addition to having decreased volume. I would suggest a breast lift confining the scar to the areola, thereby minimizing scarring. In addition I would use the smaller size implants. You may also need even smaller implants. In order to best derive on a surgical plan you need to be examined by a Board Certified plastic surgeon. Good lukc!

560(R) and 520(L) full profile look too fake?

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