I'm 5'10", 140 lbs, active runner, 39 yrs old, and 34B. What size of Sientra Breast Implants do I need? (photos)

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon

Thanks for your question. It sounds like you've narrowed your implant search down to the Sientra brand, which is an excellent choice. The variety of shapes and styles available from Sientra should allow you and your surgeon to find the perfect implant to achieve the look you want. Since you don't like the upper pole fullness (rounded look), you may be a good candidate for a shaped implant. This creates a result with a natural slope and modest upper pole fullness. As far as size goes, it is impossible to say what is best without an examination. As others have pointed out, your surgeon needs to take measurements and evaluate your physical characteristics in person. While 400 cc may not be too much to fit, it may not be the ideal choice for you as a lean-built runner. Ultimately, the decision is yours, but you should have good guidance from your surgeon. At your pre-op, be sure to have an in-depth discussion about your questions, concerns, and expectations. Try on plenty of sizers, and ask if your surgeon has access to computer imaging such as VECTRA 3-D, which lets you "preview" the look you'll get from different implants. It sounds like you're on the right track. Good luck!

Choosing breast implant size can be done in a number of ways; using as
many of them as possible only increases the information I utilize to
most accurately achieve the “look” each patient desires.

Of course, patients often have input from friends who have undergone
this operation, have a "great result," and have ____cc implants. "Get
those!" she tells you. But you probably don’t know what proportion of
her present size is her natural breast tissue, and how much is implant. Unless your breasts exactly
match your friend's pre-operative breast size (doubtful), and the rest
of your chest wall, breast base, and anatomy are the same (impossible,
unless she is your identical twin sister), you will need different implants added to your own tissue to
get similar results. Determining what size is best for you is even more
difficult if you rely on friends who advise to “not go too large” or
you will “look fat,” be top-heavy, or have a "porn-star look." Compared
to whom? Or is she just a bit jealous? I have seen entertainers, models,
and everyday women with breasts of all sizes and shapes--many of whom
ask me to give them something different: bigger, smaller, higher, or
with an improved shape. What is best for one is definitely not best for
all.

Breast augmentation is a personal choice, and while a friend’s input can be helpful, you should choose a size that makes you feel good about yourself. For MOST women, the size you
choose is not only possible, but perfect for you! Remember, you should
never have surgery to please someone else, or to try to conform to
someone else's opinion.

Plastic surgeons that perform lots of breast enlargements have
extensive experience in helping our patients choose implant sizes that
are compatible with individual anatomy. Every one of us does this
slightly differently, and some surgeons even decide for their patient.
But what about the patient's wishes? Every patient has a "perfect size"
in her mind's eye, and all we need to do is figure out what that size
is, and whether or not it will match appropriately with the patient's
chest and breast base dimensions, skin and muscle capacity, position of
the nipple-areola complex, as well as a host of individual anatomic
factors. I start with breast examination, careful measurements (everyone
is asymmetrical), and ask you what your goals are. Based on these
factors, I can determine if your requests can be achieved. For most
patients, the answer is YES! If not, I will tell you, and we try to
figure out what CAN work, and how to best get CLOSE to your ideals.

One of the best techniques
for choosing implant size is for the patient to bring photographs of
models with the desired (final) breast size to their consultation, or at
the time of surgery. The proper size implant to most closely achieve
this appearance is then chosen in the operating room. (Since we stock
all sizes and profiles of saline and silicone gel breast implants in our
surgical center, we do not have to “order in advance” and can change
based on your choices right up to the time of surgery). Photographic
examples have proven to be much more accurate than the patient
requesting a letter cup size, or trying to find a similar person via
internet search whose anatomy and/or results approximate your goals.
Don't try to match your height, weight, or preoperative breast
appearance to the photos, and don't use a stated implant size as a
guideline for choosing your implant size—just find an “AFTER” photo you
like.

Also, if your breast sizes don’t match (most women have some degree of asymmetry), we can choose different implant
sizes and/or profiles to achieve as much symmetry as possible. In more
severe cases, we can recommend appropriate procedures (such as breast
reduction, breast lift, or other surgical options) to optimize size,
shape, and position between mismatched breasts. Implant choices can be
made to help camouflage chest wall or other skeletal asymmetries caused
by scoliosis, pectus excavatum, or certain genetic syndromes.

Trying on implants in a brassiere is another excellent way
to provide some idea of desired final breast size and the implant
volume needed to achieve that size; however, it is essential not to
become overly attached to a specific bra cup size (B, C, D, etc.) or
implant volume (400cc, etc.), since the implant size you like in a bra
or top will always look
smaller when it is under your own breast tissues and chest muscle.
Typically, a woman who chooses a specific cc volume implant that she
feels looks good in her bra will be disappointed (too small) after
surgery if that exact volume implant is used in her body. A good
general rule of thumb is to add 50 to 100cc to the implant volume you
feel looks good if you choose to size in a brassiere. In other words,
if you like how a 400cc implant looks in a bra, it will take a 450-500cc
implant to look about the same size in your body.

In general, for an “average” height and weight woman, 250cc equals
about one bra cup size. A 12 ounce can of soda = 360cc. Most patients
cannot even see a difference of 50cc (3 tablespoons and 1 teaspoon).
Thus, 400cc implants will cause an increase of about 1½ cup sizes to
whatever breast volume the patient started with.You are tall, and can likely accommodate 400cc implants quite nicely, and with an appearance that approximates your goal photos. Your surgeon has experience, but you are the person who will live with these implants, so do not "leave it up to the surgeon." You should both work together to achieve the best outcome possible, and with the size you find perfect. Best wishes! Dr. Tholen