Would a larger implant help me achieve breasts that appear higher and more youthful? (photos)

Question

I cannot decide what implant size to get. I'm 5'7 124 lbs 36 yrs old. I have a lot of natural beast tissue. My breasts are deflated from losing weight. The simulation picture is with 365 cc. I want them full so that they're the most lifted possible. Do you think a larger size would aid in keeping them higher and more youthful ?

Donovan Rosas, MD · Answer

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." Communication is key as you and your surgeon create your custom surgical plan. 
With regards to your specific question, implants will not lift the breast. I would discourage you from pursuing a size based on what will deliver the greatest lift. A larger size will not combat sagging.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

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.

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

Ryan Rebowe, MD · Answer

Based on the pictures, 365cc implants seem reasonable. However, it will really depend on your actual breast measurements (otherwise known as tissue based planning). Higher profile and larger implants will give you more of a lift, but you want to make sure the implant is not going to be outside of your typical breast measurements (in particular your breast width). I would find some before and after pictures online that you like and go over these with your surgeon so that you both have a good idea of your goals moving forward.

Eric Swanson, MD · Answer

If you like the simulation, go with implants. Implants actually push the breast down a little. They do not give you a lift. If you the breasts high, then a vertical augmentation/mastopexy is the best option. If you are undecided you can always have the implants and return later for a lift, but make sure your surgeon offers the vertical lift (not the inverted-T or donut).

Gianfranco Frojo, MD · Answer

Breast augmentation will NOT lift your breasts in anyway. If your surgeon is telling you that they will, I would highly consider a new surgeon. The best way to achieve a more lifted appearance is to also have a breast lift. I would recommend seeing a board-certified plastic surgeon (American Board of Plastic Surgery); ideally, one with extensive breast aesthetic surgery experience/training such as completion of an accredited Aesthetic Society fellowship.

Daniel Barrett, MD · Answer

Dear Annaeliza,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Dallas Buchanan, MD · Answer

Thank  you for your pictures and questions. I love the Crisalix system and use it in my practice but it is not always reliable and I would not hedge my surgical decisions on the 3D imaging along. Treat it more like a tool for communication with your surgeon. To answer your question, if you want breast that are "higher" and more "youthful" (translation  perky), then you might need to consider a lift. That is the only thing that is going to reposition the nipple and the skin and change the breast mound position on the chest. If you do not want to do a lift, then you are relying on the implant volume to fill the available skin. If you put in a smaller implant, it is going to follow gravity and settle in the lowest part of the available skin and not provide the desired upper pole fullness. The only way to provide upper pole fullness without a lift would be to fill all of the available skin with a large enough implant to achieve that goal. However, this might result in a larger overall size or cup than you want and in the end will stretch the skin envelope over time. Some real photos would be helpful for a better evaluation but it is important to discuss your specific goals with your surgeon. If you really want to limit the implant size to prevent you from being "too big" but want a perkier and higher end result, you might benefit from considering a lift. 
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Hampton A. Howell, MD · Answer

Hi.  I would recommend that you go with the size that you like, not trying to go with a larger size to get a "lift".  I feel that going with a larger size implant to try and get a supposed lift just ends up backfiring on the patient.  The patient will then be larger than she desires and the extra size, bulk and weight of the implant ends up stressing out the tissues more over time, and ends up leading to stretching of the breasts with more drooping and sagging.
I would recommend consulting with a board certified plastic surgeon with good experience with breast augmentation as well as breast lifting (mastopexy), and discuss all of these concerns with that surgeon.  Good luck and take care, Dr. Howell

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating 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 (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Payman Danielpour, MD, FACS · Answer

My most common thing I tell patients is that bigger implants don’t always lead to what you’re looking for. The best way to see this is through a 3-D simulation which seems like you’ve already done. Don’t go too big because it could stretch the breast out and make them saggy. Hope that helps.

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