Surgeon suggested 405-440cc silicone over the muscle, is this an appropriate size to fill and lift my breast? (Photos)

This size increase that is mentioned in the question for sure will help fill in the skin and give superior fullness to the breasts. However, the prospect of patient posing the question states that increasing volume is not the objective. A 440 mL implant is a medium to large implant that most certainly would increase the size of one's look. It is difficult without a physical examination to determine the laxity of the skin. It is possible a smaller implant could achieve the same results at a smaller volume. There are a number of good implant sizes and profiles by all three of the big implant manufacturers of silicone gel implants that can be considered. It would also be wise to discuss with your surgeon the rationale for over the muscle implants. The majority consensus is that submuscular implants have advantages that outweigh the disadvantages. But there is a significant minority of plastic surgeons who believe in over the muscle implants. Do remember, especially if stretchmarks are present, that it is felt by many that over the muscle implants will descend more quickly than submuscular.

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

Implants do not lift breasts, just add volume. At size 36 D, each 200 cc of implant corresponds to 1 cup size change. 405-440 cc implants would take you up to a DD. Many women do not like lifts because of the vertical scars associated with the traditional techniques. For that reason, an alternative was developed called 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 can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question. A large portion of my practice is dedicated to revision breast surgery. It may seem like a good idea to put implants on top of the muscle in order to fill up the skin envelope and avoid the lift. In reality, this is the worst thing you can do. Invariably the skin will stretch and you will have much bigger implants and now require a much larger lift. Imagine this, you are already drooping and now you are putting a larger weight in your breast after you disconnect the breast tissue from the chest wall. What do you think will happen? I have seen this situation go wrong so many times that I actually wrote a paper titled "Poor Practice". On my breast revision gallery, you can see the heading termed "long-term changes associated with implants and placed on top of the muscle". The good news is that with an augmentation and a lift, you can have an excellent long-term result. Best wishes to you.

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. I would recommend continuing to discuss your concerns with your plastic surgeon or seek additional consultations to ensure that the implants you decide upon are the right ones to meet your expectations. Best wishes!