How much difference in projection is in .3cm? Is 4.3cm of projection too much for a natural look? (photo)

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look. 
The question of "too big" or "too small" is a relative question. The safest approach is to stay within the boundaries of your BWD. Ultimately, this is a question of goals. For a more "natural" and understated look, "conservative" both in profile and volume is best (especially in a smaller framed individual). I would not stress mightily over 60 cc as this is slightly more than the volume of a shot glass. On that same note, .3 cm of projection will be nearly indistinguishable post op.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

When you try on implants pay more attention to the volume than anything else.  Don't worry about the projection (in reality the projection determines your volume, but don't think about it that way).  If the volume looks right then the projection is going to be fine.If you like the volume of the smaller sizes, then select those.  If you like the volume of the 240 ml then choose that one.  Please remember that my perspective and technique for breast augmentation is unique and therefore there are going to be a lot of opinions that do not agree with what we discussed.  Ultimately you have to feel right about your decisions.  First, do you trust my experience and the "look" my patients want.  Second, what volume looks right to you.  The volume is going to determine the projection for you.  In my opinion all of the projections seem natural as long as the diameter of the implant is not too wide for your body.

Dear aks1030,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