How Big is 300 or 350cc?

Question

I’m getting a prophylactic mastectomy with implant reconstruction. I’m 5’8 and 168 lbs and wear a 36B. The doctor recommends direct implant recon and could put in a 350cc implant, worse case 300cc. He said putting in an expander might not be an option. Why do some patients not have an option to have expanders? Will a 350cc implant look really small on a woman my size? I’m worried that I won’t be happy if my breasts look too small after surgery and would like the look of at least a C cup.

Tom J. Pousti, MD · Answer

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size.  Much of the final &ldquo;look&rdquo; achieved after breast augmentation surgery  depends on several factors: 
	1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation &ldquo;look&rdquo; will be optimal.
	 2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
	 3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants. Other differences involve how the breast implants are filled. Saline implants are filled after they&rsquo;re implanted, so saline implants require a smaller incision than prefilled silicone breast implants. On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers&rsquo; saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
	 4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.
	 I hope this helps.

Michael M. Omidi, MD, FACS · Answer

Thank you for the question and photos. The
choosing of implants is a very crucial and is one that should be done through
an in-person exam.  Various aspects could affect the choice of implants
like breast tissue, body measurements, desired end result and the like.
 Bra sizes also differ from one manufacturer to another so a carefully
selected implant can be able to get you very close to that size.  It is
always best to visit a board-certified plastic surgeon and have a full
evaluation for your concern. Best of luck. Dr. Michael Omidi.

An in-person exam with a board-certified plastic
surgeon is the best way to assess your needs and provide true medical advice.

Robert L. Kraft, MD, FACS · Answer

I am sure that you have a lot to think about if you have decided to undergo prophylactic mastectomy.I would encourage you to focus upon the reason for the surgery and its potential longterm benefits in reducing the risk of breast cancer.  That said, the cosmetic result is important.   A 300 cc implant will produce no more than a B cup given that the underyling breast tissue will be removed.    Exactly how much volume it will produce is dependent upon implant placement, your chest musculature, the thickness of the skin draping over the implant and other factors.   Discuss your expectations in detail with your plastic surgeon prior to the procedure.   I generally do not favor tissue expansion because it will require supplemental surgery to replace the expander with a permanent implant or leave you with an implant with a port (which some women can feel under the skin and find objectionable).  Piggy-backing two implants also has its own problems.  It would be best if you could achieve the desired result in a one stage procedure.  Wishing you the best of outcomes!

Fereydoon S. Mahjouri, MD · Answer

It is not clear to me, why your plastic surgeon has told you that staging reconsryction by putting expander and  then replacing it with a permanent implant is not an option. 300 cc implant is approximately two cups ( B cup). If you are already B cup and want to have a size larger you should consider 400 cc implants. If these impalnts put your breast flaps under undue tension, the only logical option would be to put tissure expanders to prepare enough space to accomodate appropriate size implants.

Steven Turkeltaub, MD · Answer

There is no way that I or anyone else can provide you with accurate recommendations regarding implant size for your prophylactic mastectomy without first examining you. Photos can offer some information but not as regards implant size.

	There also is no valid reason that I know of that would preclude your ability to have tissue expanders if so warranted. If you want to be somewhat larger than you are now, this would be a potential approach.

	You should seek out 1 or more additional consultations with board certified plastic surgeons and then decide what you would like to do and with whom.

How Big is 300 or 350cc?

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How Big is 300 or 350cc?

Answers (10)

Answer: Breast augmentation & proper implant

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Answer: Prophylactic mastectomy and implant sizing

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