Does having a lot of thickness in upper pole of breasts mean I will need a bigger size implant fill them?

Thank you for your question and photographs.  I think you are starting from an excellent position and should anticipate a nice result.  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 seeing additional ASPS board certified plastic surgeons to ensure that the implants you decide upon are the right ones to meet your expectations.  It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like.  Best wishes! 

Based on your photo it would seem a 350 cc implant would give you a nice result. I'm not sure it would be the D cup you desire, but trying on sizers (as I have my patients do) would help in that decision.  Best of luck to you. 

The "pinch test", used to check upper pole breast thickness, informs a surgeon whether there is enough tissue to cover the upper half of a breast implant, so that the upper edge is not seen, if it is put above the muscles. The rough guide is that you should have around 2cm of "pinch". Less than 2cm means that the upper edge of the implant will be move visible and can give a "faker" look, and if someone is keen to avoid this look then the implants should be placed under the muscles (although there are other reasons for an against going under the muscles) to cover the upper half of the implant and give a more natural look.

I think 350cc should get you right to a full, full C or small D. The thickness in the upper pole gives you more coverage of the implant and makes it look less fake… But I think anywhere from 350 to 400 should get to where you’d like to be!

Dear gabbyleex,
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

From your photographs, it doesn't look as if you have a 4cm pinch test and I wouldn't worry about your implant "filling" the skin envelope or not. The choice of implant should be much more about the space available, your breast dimensions, diameter and the elasticity of your skin and soft tissue. It's very difficult to say whether 350cc will be adequate without examining you in person and I have found 3D imaging to be very helpful in this regard as well. The best outcomes from this type of surgery happen when these decisions are shared between patient and surgeon, underpinned by good communication and good imaging, as well as an experienced surgeon delivering reliable technique. You should feel you are able to convey your wishes to your surgeon, often helped with photographs of previous patients or images that you like. That way you will feel confident that you're going to get the results that you want. Best of luck

Having a lot of skin on the breast does not mean you have to go bigger and fill out the whole area. This only means that you will have great coverage for the implants which will give you a more natural look and feel. The best implant size, shape and texture that can help achieve your desired results involve an extensive examination and decision making. Many factors are taken into consideration when choosing an implant, such as your chest wall measurements, skin elasticity, your goal result, and the technique and skill of your chosen surgeon. All these can be determined through a physical examination. The best course of action would be to schedule an appointment with a board certified plastic surgeon for an in person examination and a detailed discussion of your surgical options.

Having more tissue means you will have a better result with coverage over your implants. No, you don't have to go bigger and stretch out this tissue more. With what you have, 350 should give you a beautiful result.

Hi and welcome to our forum!

Having satisfactory padding in the upper poles ensures that the implant will not become visible. A single photograph does not provide sufficient information to choose an implant as it it more than just a measured volume. One must consider implant diameter and projection as well. 
Determining the “perfect” breast size before a planned breast augmentation is quite a difficult task. Each individual has a different concept of “normal” breast size. In addition, there is no standardization of bra size in the manufacturing industry. One company’s “C” is another company’s “D”.

There are various ways to determine desired breast size. Bringing in “wish pix” to demonstrate to your surgeon will make him / her aware of your anticipated goals. The experienced surgeon will make certain measurements to ascertain a range of possible implant sizes.  Placing an implant in a bra gives an extremely rough idea of anticipated breast size. One may estimate volume by adding rice to a baggie ( 1 cc 1 ml) and adding the volume to your breast beneath a bra. Some surgeons offer computer imaging.

The most important measurement is the base width of the implant. If you drop a vertical line from the medial most and lateral most aspects of the breast, and measure the distance between them, this suggests a base width. If an implant is too narrow, you will not have adequate cleavage. If wider than the base width, you will have excessive cleavage and “lateral boob”.  The fill of the implant then determines the amount of forward projection. I recommend you visit an implant website (e.g. Mentor, Allergan, etc.) as they will list base widths, fill options, and projections for each implant size they offer.

I recommend a thorough discussion with your plastic surgeon to ensure that you are both on the same page.

Best wishes…

Congratulations on your upcoming breast augmentation surgery. Having a soft tissue pinch test of over 4 cm is a good finding, and will make post operative issues such as visibility and rippling less likely. I would not worry so much about overall breast volume or cc and consider the implant projection of a properly fitted implant to be more important. If your expectation is to go up from an A to D I would suggest a properly fitted High Xtra Profile or a Ulta High Profile implant. I like to have patients bring in nude photographs of patients that have a similar body habitus that have post operative results that they like and then work with my patient coordinator and sizers to find the implant choice that meets the patients desires and expectations. I suggest an in patient consultation with an experienced board certified plastic surgeon. Beast of luck.