What size implant would give upper pole fullness? 125lbs, 5’4”, wide shoulders and naturally wide breast. (Photos)

Hi MamaCricket,

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.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

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, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

If
you are a 32 DD, you do not need more volume but need your breasts reshaped and
repositioned.  I recommend is The
Bellesoma Method to create upper pole fullness without implants, elevate them
higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation
and the ability to breast feed are maintained, if not injured during your
previous surgery.  At the same time or
later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D. 

Hard to answer this without an in person exam and specific breast measurements. Remember also that there is no direct correlation between implant size (cc's) and cup size. Best option is to choose a board certified plastic surgeon who actually takes the time to measure you and examine your breast pocket. Sizers will only give you a rough estimate. The goal of breast augmentation is to optimally fill your breast pocket, not to overstuff or understuff it. At my practice, we utilize a series of 5 breast measurements that help me determine the ideal implant size, which in turn helps me deliver a 24 hour recovery. Best to choose a surgeon who takes the time to sit down with you and discuss your goals/expectations to determine the best size for you. Good luck!!

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. With regards to your specific question, the upper pole cannot be preferentially filled out without augmentation of the whole breast. More fullness will affect overall size. The best advice is to start with your BWD and work from there.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Hello and thank you for your question. You are a great candidate
for a revision breast lift with an implant added.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Thank you for your question and photographs.  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 an ASPS board certified plastic surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations. Because of the amount of your natural breast tissue, I would stick to a moderate profile implant that supplies you with the upper pole fullness but without much overall volume.  Hope this helps.

Hi. I would recommend 480-500 CC High Profile Silicone Cohesive Gel Implants to be placed under your pectoral muscles. I would recommend also skin removal from the down pole which is excessive, without touching the Nipple-Areola Complex.International Member of the American Society of Plastic Surgeons (ASPS)
Member of the International Society of Aesthetic Plastic Surgery (ISAPS)
Board Certified Plastic and Reconstructive Surgeon

It is not possible to provide good advice about implant size issues without an actual examination and various breast measurements. I will say that you have shown a propensity towards “implant bottoming out” with severe stretch beneath the nipples. During your revision procedure I would strongly recommend you discuss utilizing lower breast support grafts to prevent this “bottoming out” from happening again. Without actually naming brands there are several options of these type of support grafts. I strongly suggest you talk to your surgeon about this. 

The best advice would come from your plastic surgeon. Typically, breast measurements are taken and most surgeons will recommend a range in volume (cc's) that would look natural for you if that is the "look" you are going for. In my practice, I let patients try on sample implants to see what kind of implants looks best with their shape and size. I rarely go by cup size. Talk to your plastic surgeon.

The best cosmetic result in any particular breast augmentation patient depends on a variety of factors, including: Your individual anatomy, desired outcome, realistic expectations, a thorough discussion with the plastic surgeon about the options, and an understanding of the pros and cons of any particular implant choice. Proper sizing is not just about the number of cc’s. or the type of implant. The thickness of your tissue, breast dimensions which include the width, height, and projection, as well as chest wall width all need to be considered when choosing an implant. Trying on implant “sizers” of various shapes and volumes while wearing a tight t-shirt, bra, or bathing suit at a preoperative visit will help you and your surgeon choose the optimal implant.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California