Petite and athletic frame - I want something natural but don't want to regret choosing too small. 235cc or 275cc? (Photos)

Thanks for your question. This is a big decision, and I appreciate you taking your time to be thoughtful about the size you choose. The best way to choose is to try on sizers in the office. Some offices may even offer a sizer that you can wear at home and inflate to different volumes (ours is called the Dazzle) to try on in your usual clothes and take for a test drive. A 50 cc difference distributed over your whole breast is not a big change in size, so when my patients express anxiety about possibly going 'too small' I will encourage them to lean into the slightly larger size to avoid the most commonly reported post-op regret of not going bigger. Your anatomy is also important - and picking an implant that fits your 'base width' or measurement of the breast width should also be taken into account, and is something to discuss with your surgeon. You have great anatomy for a breast implant, and I wish you the best luck on your journey!

Sizers are implants you can fit into your bra to see and feel your predicted results. That is generally the easiest way for patients to determine what size would be most suitable. Please ask your surgeon about them.

I would recommend going to your surgeon's office one more time and trying on sizers again. Like other answers have alluded to, a 50cc difference is a very subtle change. If you feel like you are aligned the personality type like many other breast augmentation clients, after about 4-6 months, you will have wished you went slightly larger. If you are not aligned with that personality type and know that you tend to be more conservative in general, it will be a fine choice choosing 235cc. Neither is wrong, as they are a very similar aesthetic.

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing. Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look."
With regards to your specific question, I would not struggle over small volume differentials (40 ml is less than a shot glass). This is unlikely to make or break a result. If the smaller option ends up being underwhelming, the larger option is unlikely to satisfy.
Communication is key as you and your surgeon create your custom surgical plan.
As always, discuss your concerns with a board certified plastic surgeon.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

At size 32, each 100 cc of implant corresponds to 1 cup size change. 275 cc implants will take you up to almost a D. Your breasts are slightly low on the chest wall and you may benefit from a circumareola lift at the same time.

Best Wishes,

Gary Horndeski, M.D.

Good luck on your surgery. I think you are on the right track. You need to make certain that the surgeon takes accurate measurements of the footprint or diameter of your breast. It doesn’t matter what size you are or what cup size you want to be as much as trying on the implants in the office and determining if you like that with your bra and clothing. Spend about an hour doing this with the nurse.

If you are very athletic, you might want to consider putting the implant on top of the muscle, but under the fascia of the chest muscle. That way you won’t get migration from muscle contraction over the years or a window shade deformity from flexion of the chest muscle. I think you’re on the right track with the sizes. Remember 90% of people wish they were bigger a year later! Good luck.

Both implants you are considering are on the conservative side and should give you a nice result. If you are afraid of being underwhelmed you may want to go with the larger one. Many surgeons have sample implants available that you can "try on" to get an idea of how you may look after surgery. I prefer to use sizers during augmentation surgeries to help my patients get the look they are wanting. I've included a video I hope you find helpful.

Each plastic surgeon has their own way of guiding patients through the implant selection process.
Some plastic surgeons ask the patient to make the final decision other plastic surgeons will make the decision based on input from the patient.
My personal approach has always been to work with before, and after pictures of previous patients who had similar breast characteristics. I usually ask patients to bring in examples of ideal outcomes.
Once I have an understanding of what the patient is hoping to achieve I bring those pictures with me to the operating room to use as reference.
During surgery, I use temporary implant sizers to determine what size implant will give the desired outcome. Sizers are inexpensive temporary implants used for this purpose. They are never left in the patient other than during the procedure.
I usually have different size and shape implants available at my disposal during surgery.
This requires either maintaining an implant inventory or sending back implants that weren’t used.
I have found this to be the most accurate way of getting what the patient was hoping to achieve.
I think it would be inappropriate for any of us to tell you what size implant to use.
It is your surgeons responsibility to help you with your decision.
Even if you go with 275 mL, that is still fairly conservative.
My best guess is six months later you may have wished you were even larger.
When it comes to cosmetic surgery, provider selection is usually the most important variable.
In the hands of the right provider things should fall into place and decision-making should be relatively straightforward.
Finding the right plastic surgeon to work with is not at all easy or straightforward.
It usually involves having quite a few in person to consultations, which can be time-consuming and potentially involve some financial cost.
In my opinion, both financial and time spent for multiple consultations are a solid investment in yourself.
I find it interesting. That patients think spending money on multiple consultations is a waste because it doesn’t lead to a surgical outcome.
If it leads to better decision-making, then that can be worth more than money on a few extra constrains.
The level of skill and experience varies dramatically among board certified plastic surgeons.
You can read some of the other questions patients post regarding breast augmentation to recognize how often things turn out different than what the patient thought and how often the patients require revision surgery.
In my opinion, plastic surgeons are in a better position to make the implant decisions because we have far more experience than patients do.
From the surgeons perspective, putting the decision-making in the hands of the patient prevents the surgeon from being blamed of choosing the wrong implant.
I still think the surgeon is in a better position to make the decision.
Best,
Mats Hagstrom MD