Is 295cc's too big for me? I want to look natural and lovely but not too conservatively small. (photos)

Question

I'm scheduled for BA in 3 days! I'm 29 years old, 5'4, 122lbs, bra size AA with a breast width of 11cm. My first consultation the nurse recommended CPG322, 255 cc mod profile to achieve the natural and lovely look I desire. In the appointment with my surgeon I felt very rushed to pick a size but I do remember his seeming approval for my choice of 295cc after he offered it to me. *After viewing photos of women with my current breast size I am worried the 295 will be too much on me.?. Thank you!!!

Nick Slenkovich, MD · Answer

Thank you for your question.  There are actually multiple factors that determine what implant size is right for you.  Choosing your implant size is one of the most personal decisions in preparing for a breast augmentation.   An important factor when picking an implant size is your breast width.   Often times patients will come in with an idea of what size they want after researching and seeing images online, but that same sized implant often looks drastically different on two different patients.  It is important to communicate your true goals for breast size and shape during your consultation. There are a few different ways to “test” if 295ccs is the size that will help you achieve your goals.I have found 3D simulation to be a vital part of envisioning what each implant size will look like on your body.  Using the Vectra imaging system, we take pictures of your own body, and then we can work together to view different implant sizes and options.  Rice sizers are another great way to test implant sizes at home, as shown in the attached video.  To make rice sizers, simply cut off the foot of an old pair of panty hose and fill it with the correct amount of rice to mimic 450ccs.  1 cup of uncooked rice is equal to 250ccs, so to make a sizer with 295ccs, use about 1.2 cups of rice.  Once you have the rice sizer made, you can put it inside an unpadded bra to get an idea of what it will look like.  The benefit of using rice sizers is that you are able to try them on for an extended period of time, and even see what the size looks like in different clothing styles.When deciding on an implant size, I recommend a combination of communication, 3D imaging technology and the physical "trying on" of sizers.Hope this helps.Nick Slenkovich, MD, FACS

Donald Groves, MD · Answer

Hello and thank you for your question. Honestly, a formal in-person evaluation would be needed to determine the best treatment. There are several reasons for this: 
1) Bra sizes vary based on the clothing store (for example, Victoria's Secret tends to upsize everyone by a whole cup size)
2) Most women do not wear the proper exact fitting bra size for their bodies
3) The exact volume (in cc) needed to change cup size is different for different body types (e.g. 32A to 32D requires a different implant size than 38A to 38D)
4) Be careful NOT to fall into the trap most women do- they see a certain implant size (e.g. 285 cc) or perhaps their friend had a certain size, and they want or request this or another size based on that. Everyone's body is different- 285 cc implants on your friend might look VERY different than they would on you. Be very careful not to make this mistake, because the goal is to find the right size and shape for YOU- for your particular body and your breasts.

Because of those multiple factors, and because it is KEY to fully evaluate your breasts in person to make a full set of precise measurements to select the proper implant for you (incorporating factors like amount of breast tissue, implant type, base width, projection, etc), answering your question really would need a formal personalized consultation- to say anything before that would simply be guessing, which would be both unfair and unhelpful to you. Also, just FYI, each surgeon's measurements are slightly different, so numbers, experience, and overall aesthetic from one surgeon aren't necessarily the same as those from another surgeon!

Your breasts are such a KEY area of your body and your femininity- therefore, you should ONLY trust an experienced aesthetic plastic surgeon. As such an expert, I have had extensive training and experience with complex aesthetic surgeries under a multiple world-renowned experts in the field. I’d recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with aesthetic plastic surgery procedures) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Joe Gryskiewicz, MD, FACS · Answer

Hi MisHox,I suppose you just had your surgery today.  We like Mentor and I believe you are definitely on the right track.  Here are a few tips for you in case you need them or to help other readers.  Here are a few tips for you because this is perhaps
the hardest decision for a patient to make, as well as the surgeon. Also see the video attached to my answer. We spend up to two hours for our BA consults
to be sure there is careful communication. We do a full exam in front of a
full-length mirror taking six exact measurements.We
put your photos on a large computer screen for imaging, and go over your
“ideal-size” photos. We then save this information to your password protected
“web account.” First and
foremost the implant should fit the dimensions of your breast and tissue cover.
 Balancing the implant to your
over-all body shape and tissue cover is essential.The main thing is to
have the diameter of the implant fit the diameter of your breast "foot-print".
 Higher profile implants tend to have a smaller diameter.Higher is really a marketing term, but often
translates into the same volume implant with a narrower base.Saline implants actually tend to decrease in
diameter as they are inflated!The average size chosen over our last 7,000 breast implants was
“350cc”.BUT, 90% of our patients tell us they wish they were
bigger a year after BA.(We will see you
every year for routine checks at no charge.) It’s like your mind incorporates
the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients
that they will experience an increase of approximately one cup size per 200 cc.
You can try on implants in the office by
placing them into a special bra.The implant is also flattened somewhat when under
the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for
flattening of the implant in the partial sub-muscular pocket. Once you decide on a size you like, then add
on 25cc, because in real life the implant will be flattened slightly by your
tissues.Multiple measurements need to
be taken to fit an implant to your exact anatomy.  Have your surgeon's
office show you the charts of the implant dimensions for the various profiles
of silicone and saline from the manufacturer.  Then you and your surgeon
can piece together the puzzle by matching your measurements, with your wishes,
versus your tissue cover and the available implants to arrive at
a surgical plan.Keep in mind
larger implants tend to have more problems over the years.Since silicone implants wrinkle less than
saline implants, they might be your best bet.You can
also approximate this at home by measuring out an equivalent amount of rice
placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and
see what you think.Implant size must
square with assessments of tissue cover, breast diameter, and chest wall width.
Multiple measurements of your chest wall
are taken (seven in total). Implant size
selection has been an issue of much discussion. Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape. A photo album of patient
pictures is maintained to assist them. These photos ultimately help in determining
where the implants will be placed, since they can be shifted inside (to provide
more cleavage), to the outside, up or superiorly, and down or inferiorly during
surgery. In determining the final size
selection, I always place the highest priority on the preoperative measurements
and potential tissue cover.Finally,
your verbal requests are factored into the analysis. We use
the quick-recovery approach, so click on the web reference link below to have
this explained and you can see the list of Quick-Recovery (Flash-Recovery or
Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery
journals.It is a surgical procedure that
uses special instruments and techniques to minimize tissue damage and avoid
touching the ribs. It causes far less trauma to surrounding tissue than
traditional approaches, and it dramatically reduces pain and recovery time. In
published studies of BA patients, 95-percent of women interviewed after the
procedure returned to normal daily activities within 24-hours. Quick-recovery
BA is not a “gimmick.”These specialized
techniques, which actually speed recovery and get you back to your daily
routine, kids and work, are published in our plastic surgery journals.Because these PS journals are “peer-reviewed”
and edited, they are the gold-standard in our field as being valid science.
Therefore, these are sound techniques, not marketing hype.Be sure
to see only a board certified plastic surgeon (by ABPS - The American Board of
Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic
Plastic Surgery) and or a member of ASPS (The American Society of Plastic
Surgeons). Also, ask if the PS has an
established, high volume breast augmentation practice, performing several
hundred breast augmentations each year. Be sure the PS has been in practice for a
while, about 20-years might be a good gauge.Does the PS offer all three incisions?Discuss the implant type (gel or saline), shaped "gummy bear"
or non-shaped, smooth or textured, implant pocket (over or under the muscle)
and the "quick-recovery approach."Ask to see their before and after photos if you didn’t see any on their
website.  If they are experienced, they should have several 100 breast
implant patients for you to view.  I would also recommend that your doctor
offer you the chance to talk to past patients who would be happy to discuss
their experience with you.  You need to feel comfortable, so make sure the
environment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or she
has ever published journal articles in professional peer-reviewed journals,
which they can provide you.All the best, “Dr. Joe”

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you is dictated by your
chest wall measurements.  Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid
silicone (less cross-linked), if this implant should rupture, it will leak only
into the scar capsule formed around the implant but may cause some discomfort
or implant distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone
gel implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and
try on various implant sizers in front of a mirror to help you to get an idea
of how you will look following the surgery. You should also bring pictures of
the look you would like to achieve, as well as a favorite top to wear when
trying on implant sizers.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.Best of luck!

Dr. Schwartz

Board
Certified Plastic Surgeon

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon

Tom J. Pousti, MD · Answer

Thank you for the question. 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 know words such as “natural and lovely” or "C cup” 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 (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Marc J. Salzman, MD, FACS (retired) · Answer

This
is a common question asked not only in forums, but also in the offices of
cosmetic plastic surgeons. It seems to be a source of some angst for most women
as they have tremendous concern for what the final outcome might be. I find
that several things over the last 25 years have helped patients decide which
type, shape, and projection ratios will best suit their needs. I think it's
helpful if the patient brings in several photographs of what the goal look of
her breasts might be. Also, if she can bring some photographs of what she
doesn't want this will eliminate trying to express in words what “natural”,
“high cleavage”, “low cleavage”, “fake”, and “stripper” may mean to her. I have
likewise found the Vectra 3-D imaging platform to be the single most helpful
tool in trying to visualize what the outcome might be with different sizes of
implants. The Mentor shell sizing system, in which a shell of implant material
is placed over the breast and in a padless bra, can likewise be helpful in that
it can, not only show the size in a bra, but can give the patient some idea as
to what the weight of the implant might be.In my opinion, the implants will
look best when the base width of the implant is at, or just slightly less, than
a natural base width of her breast. Considerations of chest wall abnormalities,
location of breast creases, shapes of the breast, amount of overlying breast
tissue, stretch ability of the skin and breast over the implant among other
things also play a role in trying to best decide which implant will look best.
It can also be helpful if the plastic surgeon, during their consultation, can
provide some insight into what the likely outcome would be with different sized
implants given their experience in breast implant surgery over many years. We
ask our patients to bring different types of clothing such as evening gowns and
bathing suits as well as a tight shirt to evaluate what the implant might look
like under these type of clothing options. It is also possible to make a home
made breast size or using grain rice. Approximately 1 ounce of rice equals 30
mL of breast implants volume. The rice can be placed into a pantyhose leg and
enough volume left in the pantyhose such that the rice can be flattened out.
You can then tie off the pantyhose and cut off the excess. This flattened rice
volume pantyhose can be added on top of the breast inside of a padless bra and
can give a rough approximation of what the corresponding implant might look
like. Besides the size, most plastic surgical consultations for breast
augmentation will also deal with the shape of implants, whether round or
anatomically shaped. Here I think the Vectra really shines in that you can
place two images next to each other, one with the shaped implant and one with a
round implant such that the potential breast implant patient can really see
what the difference would look like on them. All things considered, this can be
a fun process and the vast majority of patients in my practice are quite happy
with their end result. Hope your surgery goes well and good luck.

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