315cc or 335cc Motiva implant?

Question

Currently i am 34AA /A. Ideally i would like a suttle small increase breast size. I am 11.5cm BWD, 5cm under breast fold tissue, 172cm height, 62kg weight. I have been recommended motiva full 315cc or 335cc under the muscle. I like the look of the 295cc and 315cc sample sizes but i have been advised to go the next size up due to the appearance of the implant looking slightly smaller once placed under the muscle. Is this true? If i like the look of 315cc, i should go 335cc?

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.  315cc and 335cc are close in size.  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

Kenneth Hughes, MD · Answer

You will probably not notice the difference between the 335 and 315 cc Motiva implants.  The implants will look a bit smaller, particularly in the submuscular position.  There is no rule here, but you may want to add about 10% to the size you select so recommend the larger size.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Mark Baldwin, MBBS · Answer

Breast implant sizing is a bit of a dark art. There simply isn't a formula that's reliable. The main issue I have with giving you a concrete answer is not knowing what the 'sample sizes' you tried were. Intraoperative sizers? Mentor sizing kit breast forms? Rice sizers or similar? I'm guessing the most commonly used are intraoperative sizers, so if that's what you used, then I need to know what sort of bra were they tested in? In a tshirt as well or just the bra? etc etc.
You can see why the only sensible answer I have is 'ask your surgeon'.
Having said that, the best advice I can give you on the internet is to keep a sense of perspective...20cc difference is not much. 
Regards, Mark

Raymond Goh, MBBS (Hons), FRACS (Plast) · Answer

Hi. Both implants would suit you well. There is VERY LITTLE difference in the final result between the two. 20cc is very negligible. You may not even distinguish the difference if you had 315 in one breast and 335 in the other. It is true that the breasts will be a little smaller once placed behind the muscle. 
All the very best
Dr Ray Goh

Daniel Barrett, MD · Answer

Hi Newjean,
  
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, MD, MHA, MS
  
Certified, American Board of Plastic Surgery 
  
Member, Am. Society of Plastic Surgery

Tom J. Pousti, MD · Answer

In my opinion, it is not possible to accurately determine how many ccs (if any) a patient would “lose” when undergoing sub muscular breast augmentation surgery. I suggest patients do not make decisions based on statement such as: “you will lose 25 or 50 cc of volume when breast implants are placed under the muscle”. These statements are simply not reliable enough to utilize clinically. My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
One question that might be helpful for you to consider: would you be more disappointed if you are slightly too big or slightly too small after the breast augmentation procedure?
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” or "C 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 helps. Best wishes for an outcome that you will be very pleased with.

Ashok Govila, FRCS, MCh, MS - Account Suspended · Answer

Hello
It is a complicated process to select the type, size of breast implant and its level of placement that requires a detailed consultation (in my practice couple of times at least 2 to 3 sessions) that includes a detailed surgical discussion with their prone and cones.
My primary need is to reach to what exact look my patient is looking for and towards this goes I tell them to bring at least some pictures of bare breasts of celebrities from net.
I then make an assessment of the quality of tissue, the size of infrastructural support like the rib cage and collar bone width of shoulders, the texture and thickness of the muscles that I am going to work with, mainly pectorals.
A primary assessment of patient’s breast volume is made at this stage. A similar assessment of breast volume is then made of the selected goal pictures. The difference in the volume should be the size of breast implant that should use if I can know that there are enough skin and other soft tissue envelopes available for her. This helps to check the breast sample sizes now in the clinic and later during the surgery.
A sample implant sizer is placed in the pocket created under or over the muscle or on the dual plan and table is turned to the semi sitting position while the patient is intubated during surgery and assessment is then made about the symmetry shape and size of both breasts before the surgery is closed.
The level is then lowered to normal levels and wounds closed by internal stitched only since I do not use any suturing outside the skin.
I do not leave any drains since I make sure that hemostasis is perfect before I close.
It's better to pay several visits before surgery to reach conclusions with wisdom since you don't want to invest time and money into a result that is either too big or too small even if the post-operative course and surgery itself was uneventful.
I wish you all the best
Professor Dr Ashok Govila
Board certified Plastic surgeon and author

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