So confused about size of implants and technique.

I have been thinking for long time about BA. Now I am ready for it so I am looking for the good surgeon. So far, I have seen 2 and their opinion are so opposite that I am completely lost now. After 2 babies and breastfeeding my breast are empty. So the 1st one told me the max I can get is 300 and has to be under the muscle as I don't have much tissue. The 2nd one told me he will do 350cc and on the muscle as I have more then enough tissue. Who should I listen to ?

Doctor Answers 9

Confused about Breast Augmentation


Sorry to hear you are getting conflicting advice.

50cc is a small difference and will not be that noticeable. There are good and bad points regarding putting an implant under the muscle. This will tend to hide the edge of the implant if you have less than a centimetre of tissue that you can pinch on the upper part of the breast but the implants tend to look a little smaller and can move when you flex these muscles.

Over the muscle risks a visible edge on the upper part of the breast and long term you may see ripples but it all depends on how much tissue you have on the upper part of your chest. in general if you can see your ribs then you are probably going to need to go under the muscle.

I use a 3D system to show a preview of implant sizes and maybe you see a surgeon who offers this to help you preview different results.

best wishes 

Manchester Plastic Surgeon
5.0 out of 5 stars 15 reviews

Deciding implant pocket of placement and implant size

Thank you for your question!

Your queries can best be addressed with an in-person consultation and a breast exam. However, you must definitely be confused as you already did that with 2 surgeons and received 2 different suggestions.

It is normal for mothers such as yourself to have deflated breasts, and would require breast augmentation for getting back to breast size they previously had.

However, the implant has to be chosen in relation of your preferences, your breast anatomy, characteristics and boundaries. Only when the implant is tailored to your breasts, then you can get natural-looking results. The more you deviate from the proper fit, the more fake your breasts will look.

An evidence-based method to identify the implant size is called tissue-based planning. The planning takes into account the effects of implants on tissues over time, risks of excessive stretch, excessive thinning, visible or palpable implant edges, visible traction rippling, ptosis (Sagging), and breast tissue wasting. The planning involves making certain breast measurements such as the base width of the existing breast tissue, breast skin stretch, and nipple to inframammary fold distance. The implant size that will be identified will be the one which will adequately and appropriately fill your breasts while keeping long-term results under consideration.

Finally, with regards to the pocket of implant placement, I would first like you to know that the decision to go behind the muscle or over the muscle has to do with the amount of soft tissue coverage – “padding” you have under the skin. Choosing a pocket that is tight with sufficient soft tissue coverage not only prevents implant visibility, palpability, and risks of excessive stretching on the breast, but also excessive implant movement into the outer or inner sides of the breasts. A hand-in-glove fit for the implant allows for a natural and long-lasting result. Your surgeon will do a pinch test in the upper pole of the breast to see how much “padding” you have. If you have less than 2 cm, then you do not have much padding and it would be best to go under the muscle. Generally speaking, if your ribs are visible under the muscle, then you do not have much “padding.” If however, you have more than 2 cm of tissue, then you have the option to go over the muscle or under the muscle

Which pocket do you prefer?


If you are hoping to fully preserve the functionality of the pectoralis major muscle due to athletics or body building, or if you have a shapeless, constricted, tuberous, sagging breasts without cleavage, then over the muscle may be a better option.

  • Over the muscle implant placement causes less trauma to the chest muscles, and the implants will not be subjected to any pressure or injury due to muscle movement.
  • The implant can directly apply pressure on breast tissue to shape the breasts.
  • However, over the muscle implant placement may have higher risks of breast tissue wasting, interference with mammography, and capsular contracture compared to under the muscle placement.
  • Higher risk of implant visibility and palpability is possible if you are thin, and this can be fixed used fat grafting where areas with less tissue coverage are filled with your own fat to provide better contour and coverage.


Under the muscle (partially submuscular) is a preferred option for many surgeons because the muscle helps to maintain a slope for the upper pole while allowing for a curvature in the lower pole, while over the muscle will mostly make your breasts appear round and augmented.

  • In thin patients, additional coverage by the muscle reduces the risk of implant visibility in the upper and inner sides of the breasts. It also reduces risk of synmastia, and provides less interference with mammography and breast imaging. It also brings lower rates of capsular contracture.
  • However, under the muscle implant placement may allow the chest muscles to put pressure on the implant distorting the breast shape and position in the long-term. You may experience more pain following surgery due to the dissection of some muscle attachments and you may lose strength while flexing your chest muscle and is not suitable for athletes and body builders.

All this being said, if you trust your surgeon and their judgment and the decision-making method used to choose the implant size, then you should be in good hands. Make sure to fully and comprehensively share your desires, expectations, and concerns to avoid miscommunication and post-operative concerns/regrets.

Hope this helps, and best of luck!

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

Breast Augmentation - Size Selection

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. 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 breast surgery. Hope this helps and good luck with your surgery.

Steven J. Rottman, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 78 reviews

Focus on the look not the cc or cup size

Focus on the look not the cc or cup size. Patient's often regret decisions based on extraneous factors as you may end up with suboptimal result. Bra's vary from store to store, and cc's mean nothing in isolation. You should be measured during your consult and offered implants within a 5mm window of those measurements in multiple styles. For what's its worth, in my experience a dimensionally sound mod+ profile tends to go from an A+/B- to the magical full C or small D. A high profile (or SRF) would be about 100ccs larger to maintain the same base width and more like a Full D but VS will call it a DD or DDD, particularly in a 32-34. Ultimately, try on the different styles and look in the mirror. When you see the look you like, pick that style! This requires a consult, exam, measurements and sizing with a board certified plastic surgeon. My patients select the implant style and their chest dimensions dictate the number of cc's. I make specific recommendations to each and every of the augmentation patients I see annually based on: 1) dimensional planning 2) expressed goals 3) amount and quality of tissue to hide the implant. I have included a link with my explanation of the different implants and what to expect from your consult as well as hundreds of before and after photos to see what change implants of a particular size deliver. Best of luck. #drfeldman #BancroftFeldman #breastaugmentation #sugarland #HoustonTX

Evan Feldman, MD, FACS
Texas Plastic Surgeon
5.0 out of 5 stars 86 reviews

So confused about size of implants and technique.

. Size and shape of breasts can often play a critical role in a woman’s self-esteem. Fuller and bigger breasts are often associated with reproducibility therefore it is a desired condition. There are different kinds of breast augmentation operation types. Breast augmentation can be performed either with breast implants or autologous fat transfer. There are also different types of breast implants like teardrop or round implants. These implants also can be placed under or above the muscle. As you can imagine there are several different options for breast augmentation. The best way to understand which one is more suitable for you is to get a physical examination by a plastic surgeon.

It is important for you to understand that you don’t always need a breast implant for breast augmentation. As it was also mentioned above you can also get bigger and natural breasts with Cihantimur Fat Transfer method. In this method we use own fat tissue of the patient in order to increase the size of the breast. Since this tissue is your own tissue there is no risk for any adverse effects. It is safe and fast operation that yields natural results without any incision.


Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.9 out of 5 stars 90 reviews

So confused about size of implants and technique.

The size of your implants should be determined by the base width of your breast which your surgeons should measure. It is always preferable to place the implant under the muscle-it provides better implant coverage, prevents sagging as much as if placed on top, and there is less risk of hardening or capsular contracture. Read the link below for more information on sizing:

BA sizes

Hello dear, thanks for your post and provided information as well. 

The thing about size is...
Did You Know? Implant size (measured by cubic centimeters, or “cc”) only matters as far as it will help you get the look you want. In these photos, can you guess who has the larger sized implants?

What limits how big you should go?

1. Your current breast size. This matters because you’ve got to have enough existing breast tissue to cover the implant. If you haven’t got a lot to spare, some implants may just be too big to fit.
2. Your chest and shoulder width. Fortunately, implants come in different base widths so you can get a size that works well with your frame.

I recommend to make an appointment with a board certified plastic surgeon for a person evaluation and to talk about your goals. 

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 396 reviews

Choosing the proper breast procedure

Without photos, there is no way to help you make a better decision. Perhaps you shoudl resubmit this whith a photo and you will get more help.

Best of luck,

Vincent Marin, MD

San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews


The difference between 300 and 350 cc is about three tablespoons difference in volume.

Over and under the muscle can both be effective and photos would help.

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.