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

Question

I’m still undecided about the size. I don’t want to have significantly larger breasts, just some more fullness. My BWD is 8.5 (!!) so my doctor says the widest I can go is ~9.5. I’ve tentatively decided on the Naturelle UHP 240 9.6 diameter, 4.3 projection. I’m worried these may be bigger than I’d like, and am worried about the projection. Should I go for something smaller, like a Mentor HP 200 (9.7 : 4.0) or a Naturelle style 20 180cc (9.6 : 3.8)?

Donovan Rosas, MD · Answer

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).

Richard H. Fryer, MD · Answer

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.

Daniel Barrett, MD · Answer

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

Graeme J. Southwick, MBBS, FRACS · Answer

Thank you for your question. It sounds like you have gotten some expert advice from your specialist plastic surgeon, and so I recommend that you continue talking with them to determine the right size and projection for your implants. Your surgeon has examined you and measured you, and has the sizers to try on, so they are truly the best resource for making this decision. It ultimately comes down to what you are comfortable with, and trusting that your surgeon will give you the right guidance to achieve the best possible results. Good luck!

Barry L. Eppley, MD, DMD · Answer

The look that breast implant projection and volume size make is highly dependent on whose chest on whom they are placed. It is clear based on your examples that you do want a very small breast size which is completely compatible with a natural look. A 0.3cm difference in projection is roughly 7mms or almost 1.3 of an inch.ith your concerns, when in doubt, always go smaller,

Jon Kurkjian, MD · Answer

Thank you for your question and photos
There are several variables to be considered when answering this question. It is always difficult to make a diagnosis based on photos alone, however, an augmentation with a smooth round silicone implant could acheive these results. When you meet with a board certified plastic surgeon, they will perform a set of measurements that will help determine what size of implants will fit your body.  I hope this is helpful

Tom J. Pousti, MD · Answer

I would share your concerns, given your personal goals, that the use of ultra high profile breast implants may not be ideal in your case.My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
 Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "more fulness” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.

James Clayton, MD (retired) · Answer

The amount of projection between the implants you list in your inquiry is very close (0.3 cm is just over 1/10th of an inch; 0.2 cm is just under 1/10th of an inch). So you can see that these projection differences is essentially nearly the same, and it would be hard to tell the difference when one or the other were placed during surgery.  The more important difference in the implants is the volume size.  Your surgeon will be the best guide to help you choose which is the best implant to achieve your goals.

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