What size implant to fill out deflated breasts? Currently, a 34D, want to go back to a 34DDD/F. (Photos)

Question

So after kids and weight changes my breasts have really deflated. Before my daughter, I was naturally blessed with full DDs+, and want to get them back. I met with a couple plastic surgeons for consults and they think I'll have great results with implants. I'm wondering how big I'll need to go To get back the size I want. I'm a 34 D now, skin is lose and stretched but both Drs said no lift is needed. My bf, who has been encouraging me to do this for years, says bigger the better.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.
  
The size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance.  Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.  
  
Silicone will give you a fullness at the top (upper pole fullness).
  
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.
  
Anatomic gummy bear implants might be a good choice to give you volume.
  
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
  
During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.
  
The best way to assess and give true advice would be an in-person exam.
  
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
  
Best of luck!
  
Dr. Schwartz
  
Board Certified Plastic Surgeon
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Leila Kasrai, MD, FRCSC · Answer

Based on your photos, it looks like you probably won’t need a breast lift. Breast implants may be sufficient in giving you perkier and larger breasts. It’s difficult to say what size of implant you’d need to achieve your desired cup size, particularly since cup size isn’t standardized by bra manufacturers. I recommend you bring a bra in your desired size to your surgeon, and then try on implant sizers to see which you would like.

Joe Gryskiewicz, MD, FACS · Answer

Hi E,I agree.  No lift.  Here are a few tips for you because this is perhaps the hardest decision for a patient to make, as well as the surgeon.  Also see the video attached to my answer.  We spend up to two hours for our BA consults to be sure there is careful communication. We do a full exam in front of a full-length mirror taking six exact measurements.    We put your photos on a large computer screen for imaging, and go over your “ideal-size” photos. We then save this information to your password protected “web account.”     
     First and foremost the implant should fit the dimensions of your breast and tissue cover.  Balancing the implant to your over-all body shape and tissue cover is essential.    The main thing is to have the diameter of the implant fit the diameter of your breast "foot-print".  Higher profile implants tend to have a smaller diameter.  Higher is really a marketing term, but often translates into the same volume implant with a narrower base.  Saline implants actually tend to decrease in diameter as they are inflated!  The average size chosen over our last 7,000 breast implants was “350cc”.  BUT, 90% of our patients tell us they wish they were bigger a year after BA.  (We will see you every year for routine checks at no charge.) It’s like your mind incorporates the "new you" into your own self-image over a period of time. 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.  The implant is also flattened somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) 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 25cc, 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.  Finally, your verbal requests are factored into the analysis. 
  
     We use the quick-recovery approach, so click on the web reference link below to have this explained and you can see the list of Quick-Recovery (Flash-Recovery or Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery journals.  It is a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs. It causes far less trauma to surrounding tissue than traditional approaches, and it dramatically reduces pain and recovery time. In published studies of BA patients, 95-percent of women interviewed after the procedure returned to normal daily activities within 24-hours. Quick-recovery BA is not a “gimmick.”  These specialized techniques, which actually speed recovery and get you back to your daily routine, kids and work, are published in our plastic surgery journals.  Because these PS journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science. Therefore, these are sound techniques, not marketing hype.  
  
     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 the PS has 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, about 20-years 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. Go for it!!         
All the best, “Dr. Joe”

Ira H. Rex III, MD · Answer

This can be a very tricky situation to get the patient exactly what they want. There are many variables that have to be considered and this can only be done after a close examination. You should let your plastic surgeon guide you in finding the right implant that suits your needs.

William Andrade, MD · Answer

Hello, larger implants may help to fill out your breasts but they also might lead to premature sagging after the operation. Your PS will be able to guide you based on your breast dimensions, skin tone, and other factors.

Don W. Griffin, MD · Answer

I find that it is best to pick an implant that dimensionally matches your chest/breast dimensions, then try on sizers in a bra to determine the look you are trying to achieve. There will be several sizes and profiles that will work for your frame and using sizers lets you see them visually and helps to determine the size that works best for you.

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.   The size,
profile, and shape of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their
results.   
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Nelson Castillo, MD · Answer

Thank you for your question and photographs. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing an ASPS board certified plastic surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations. It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like. Best wishes!

Kiran Polavarapu, MD · Answer

Thank you for your question. Unfortunately, it is difficult to recommend an exact size without a full consultation. A plastic surgeon typically prefers to examine the tissue quality and thickness as well as take measurement to find the correct size. I suggest seeking a consultation in your area to get an idea of the best size for you.

What size implant to fill out deflated breasts? Currently, a 34D, want to go back to a 34DDD/F. (Photos)

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