What implant size should I get? (photos)

Hello, it is important for you to discuss with your surgeon the advantages versus risks of closing the breast bone gap using implants. Many of my patients have a similar goal of creating tight cleavage with their implants. However, if there is a natural gap between the breasts (as there appears to be in your photos) and the implants are placed close together to fill the gap, they will be only be covered by a thin layer of tissue in the centre of your chest. This means there will be a higher risk of seeing unsightly implant ripples in this area. All implants (even cohesive gel "gummy bear" implants) fold and ripple to some extent in the body so this might be visible if though the thin layer of skin covering the implants. I personally recommend my patients choose implants that actually match their breast width and place them under the breast tissue, even if it means there will be a breast bone (sternal) gap after. However, those who still want their implants close together are advised of the risks of implant palpability and rippling contour in the cleavage region. As mentioned, your own surgeon will be the best source of advice since they would have done a proper in-person examination.

Your breasts are widely separated and have very little tissue in the cleavage area. Augmentation alone will be inadequate to correct this problem. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Good afternoon,
The BWD is one of the many considerations in choosing an implant- however you also have to look at the gap you have now. You have a wide gap- if you choose an implant the same or less than your breast width then the gap won't change- you need an implant with a diameter greater than your BWD with enough width to fill in that gap.

First of all ignore the bwd thing. It's not a good way to select size. The 385 too small. The others are both fine. You probably wouldn't notice the difference between the two.

Dear fitness_chick123,
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

Hi. To appropriately discuss implant size and choice, you really need an in person evaluation by a plastic surgeon with good experience with breast augmentation. Opinions and preferences will vary somewhat from one surgeon to another surgeon. Personally I start with the base width of the patient as the starting point for the footprint of the future implant. Tissue characteristics, and desired postoperative size, and patient anatomy all factor in to the proper selection of implant volume as well as profile.

Breast implants can come in a variety of shapes, sizes, texturing, and materials. For someone new to this, it can seem overwhelming. So, as a plastic surgeon, I want to be able to make that a reasonably clear process for my patients and for them to understand their options and make a well informed decision that his right for them specifically.

Currently, my "go to" implant is a smooth round device, which may be silicone gel, or saline. Within the silicone gel implant family there are various options as well, mainly with different levels of how cohesive a silicone gel implant is, but also with the shape of the implant. My most commonly used silicone gel implant is one that is smooth and round with a cohesive level that has a great balance of being cohesive but also being very nice and soft and natural. Personally, I will place a silicone gel implant either above or below the muscle, depending on multiple factors which I discuss during my consultation with my patient.

The more cohesive the implant is, be more that it keeps it shape, but that comes with the implant being slightly more firm. When people refer to a "gummy bear" implant, most people are referring to a teardrop-shaped (anatomic-type shape) silicone gel implant, that is the most cohesive so that it keeps its shape. This may also be referred to as a "form stable" silicone gel implant. It is typically textured to try to help that implant stay in the proper position. That implant can have its advantages in terms of making the upper portion of the breast have a more naturally full slope. Some patients prefer that, while other patients prefer more fullness in the upper portion of the breast, such as what you more typically get with a round implant. In a similar fashion, some patients are okay with the slightly more firm feel that you get with a form stable implant, and others prefer an implant that is softer and more natural. Currently, with some of the controversy surrounding textured breast implants, I am pretty much only using smooth round breast implants.

A saline implant can also be a good option. This is typically more straightforward from a monitoring standpoint, in terms of whether the implant is leaking or not, but it does not tend to feel quite as natural. Because of that, I put almost all of my saline implants under the muscle, in what is referred to as a "dual-plane" position to help camouflage the implant. For a saline implant, I pretty much only use a smooth, round device.

I go over all of that all in detail with my patients at the time of their consultation.
I would recommend consulting with a board-certified plastic surgeon with good experience in this area. He or she can thoroughly review the options with you so that you can make a good and well-informed mutual decision.

Good luck and take care,
Dr. Howell

Thank you for sharing 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. As the supplied implant sizes and styles are quite different I would advocate additional consults so that you can get greater clarification on which will provide you the result you are most interested in. Best wishes!

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

I would suggest meeting with a board certified plastic surgeon and trying on both sizes to see what you like. Please do not choose an implant that is too large and heavy for your tissue and frame.