Are 425cc silicone implants too big for me? (photos)

Question

Dear Doctors! My doctor decided to do donut lift with 425 cc moderate silicone implant (under muscle). I am 5'2" 110 lbs and were naturally large breasted before children and prolonged breastfeeding. I dont want to look like a [RS bleep] star:) i just want to have back what I had. I am afraid 425 cc would be too big. Do you think we have taken right decision? Thank you

Vaishali B. Doolabh, MD, FACS · Answer

Hi tummymummy23.  Knowing your breast measurements would be helpful in suggesting implant sizes, as well as knowing what your desired bra size is.  If you can, try on different sizers in a cami or swimsuit top so that you can decide if you like the look of a 425cc.  You would get full cleavage and fullness with a variety of sizes and profiles, fine tuning the implant selection depends upon your measurements, soft tissue thickness, preferences and surgeon's recommendations. Good luck,

Emmanuel Mallol Cotes, MD · Answer

Thanks for the question. After looking the photos you sent to us, i can sat that 425cc probably will be a lot for you. I recommend you volumes between 350-400, placing them under the muscle, for a natural appearance. A personal evaluation is crucial to talk about clearly of your expectations and desire results. Kind regards

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a breast lift. Your nipple sits below the
inframammary fold and without a lift in addition to the implant, this will not
have a natural shape.  A breast lift with an implant can result in a very
nice shape if good technique is used.   425 cc may be too large for your goals.   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.   
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Daniel Barrett, MD · Answer

Hi tummymummy23, 
  
Determining the idea breast size and matching that goal for the patient is the most difficult part of breast augmentation. It starts and ends with the patient. 
  
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.
  
Make sure your surgeon understands your goals.
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery 
  
Member, Am. Society of Plastic Surgery

Dean Fardo, MD · Answer

Choosing the best implant size for you is an important decision and based on many factors.  Only an in person exam with your doctor can give you the best information.  But based on your pictures and what you stated, I think that 425cc would likely be too large.  Also, a circumvertical lift would likely give you a better result and shape.  A donut lift is best reserved for nipple position change and does not do much to help the tissue sagging below the inframammary fold.  I would recommend re-discussing with your surgeon.  Good luck.

J. Garrett Harper, MD · Answer

1. A 425 cc implant comes in all different dimensions (width and projection).  You need a device that fits the base width of your breast and then choose a device profile to change your "look" or cup size.  For instance, you could use a 425 cc high profile device that has a width of 12.5 cm and a projection of 5.0 cm OR use a 425 cc moderate device that is 14.6 cm wide and projects 3.4 cm off your chest.  Those implants would give an entirely different look and would be completely inappropriate on some women.2. Donut lifts are not a good idea.  I understand you might be against the added incisions, but donut lifts tend to flatten you at the nipple and spread the areola.  The scar rarely looks great.  With your degree of asymmetry, you need a formal lift and small amount of tissue removed from the larger size.I hope this helps.-JGH

Tom J. Pousti, MD · Answer

Thank you for the question. There will be no "universal"  answer;  what type/size/profile of breast implant can be utilized during breast augmentation/lifting surgery is a decision that needs to be individualized depending on the patient's specific circumstances (anatomy and goals).Based on your photographs, I would be very concerned that a Benelli breast lift will not be powerful enough of a breast lift to achieve an outcome that you will be pleased with (be careful with your decision-making).
Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
Also, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting 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. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or 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. I have found that the use of words such as “natural” or "C or D cup" or "porn star" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. The use of computer imaging may be very helpful during this communication phase.
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. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
I hope this, and the attached link (dedicated to breast lifting surgery concerns), helps.

Brooke R. Seckel, MD, FACS (retired) · Answer

If you are concerned that 425 cc implants are too big for you than they most likely are. You have adequate breast tissue so a smaller implant will still give you a nice result.  The implant size should be based on a measurement of the width of your breast and the implant should be the same with or smaller.  I would urge her not to have a donut type mastopexy.  For proper elevation of the nipple you will need a breast lift with a vertical component..  To understand the risks of not having a full lift please read the link below:

Are 425cc silicone implants too big for me? (photos)

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