I'm a 34B looking to enlarge to D. How can I determine what size is right? Silicone, saline?

Doctor Answers 6

Picking the right implant size to achieve your goals

Dear isabel_m:

Cup sizes are not the best way to pick your implants because cup sizes are not standardized.  A D cup to you could be a C or B or DD cup to someone else.  This is because cup sizes vary significantly based on your designer preference.  Rather, in terms of picking the right implants to achieve your goals, generally speaking, I consider two factors when selecting implants for my patients:

1. Dimensional planning
2. Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look. Hope this helps.

Dr. Basu
Houston, TX

Ultimate cup size is difficult to accurately predict

Thanks for your question. This might be the most common question we get. Current size, shape and anatomy are the biggest things that influence implant choices. This coupled with your desired look is how the ideal implant is chosen. An examination that includes measurements is essential. Find a Board Certified Plastic Surgeon in your area that is an ASAPS member and specializes in cosmetic breast surgery. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 84 reviews

Sizing for implants

It would be really helpful to have a full consultation with breast measurements taken. Using this information, your plastic surgeon can help you chose the appropriate implants and the " look" you are going for and advise you to give you your desired look. There is no ideal correlation with volume of an implant and "cup size" due to many variables including the patient current breast volume and breast shape. There are advantages and disadvantages for each choice in regards to saline and silicone.

Kiran Polavarapu, MD
Fort Worth Plastic Surgeon
5.0 out of 5 stars 33 reviews

34B looking to enlarge to D. How can I determine what size is right? Silicone, saline?

The best cosmetic result in any particular breast augmentation patient depends on a variety of factors, including: your individual anatomy, 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. 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 sit at a preoperative visit will help you and your surgeon choose the optimal implant.

There are no manufacturers' standards for cup sizing in the bra industry. The cups of a 34 D and a 38 D are significantly different. Cup size varies from manufacturer to manufacturer and even within styles from any particular manufacturer. There is no direct correlation between implant number of cc's and cup size in any particular patient.

Both the saline and silicone implants have the same type of outer rubbery silicone shell. The inner fill is different: sterile saline solution in the saline Implant and silicone gel in the silicone Implant. There are advantages and disadvantages of each type of implant. Both are utilized by surgeons across the country with satisfactory results. They are both safe and approved for usage by the FDA. Currently there are more silicone gel implants used in the U.S. While either implant can produce excellent cosmetic results in the appropriate patient, most patients prefer the feel of the silicone gel implant

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly 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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

I'm a 34B looking to enlarge to D. How can I determine what size is right?

Thank you for the question. There is no accurate/reliable/predictable correlation between size/profile breast implant utilized and cup size achieved. In my opinions, I do not think that the generalizations of "150 cc or 200 cc equates to 1 cup" hold any validity or is helpful in any specific way. There are simply too many variables such as a specific patient's dimensions and the variability in bra manufacturer's cup sizes…

In regards to the saline versus silicone gel breast implant question: the type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue.

Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.

On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants.

In my practice, I individualize the type of breast implant utilized based on many factors, including the patient's starting anatomy, the potential for weight gain/loss after surgery, patient concerns regarding each type of breast implant, and (probably most importantly) the patient's goals.

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural look” or "D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Selecting the Right Implants

With regards to saline versus silicone, I would recommend silicone as it is a softer, better feeling, more natural implant with less risks of rippling or tissue trauma over time. Sizing is based on a number of variables including your breast base width, your overall height and weight, skin elasticity, and personal sense of aesthetics, among other things. If you go online there are cups of rice to cc conversion apps, which you can use to stuff your bra and get a ballpark idea of what implant size you might like. Ultimately, the size decision should be made in conjunction with an experienced plastic surgeon that will understand what size range will work for you both aesthetically and anatomically.

Robert Cohen, MD
Santa Monica Plastic Surgeon
5.0 out of 5 stars 40 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.