Unsure of what size implants to get? (Photo)

I am a 36D currently and am struggling to decide on size for implants. My doctor recommends mod plus saline unders. I want to be big but will 600cc be too big on me? I am 5'10 and have broad shoulders and breast width of 15cm. Thanks!

Doctor Answers 11

Implants

You have grade 3 ptosis (nipple lower than the inferior breast fold) and slight constriction of the lower pole.  I would recommend a periareolar lift with a moderately sized implant, in the 400 cc range.  A 600 cc implant may end up being pushed high on your chest wall with the nipple remaining in the lower pole. 

Breast Implants

Hi AJB,

You can carry any size implant you want based on your post above because of your height and breast width.  See the answer by a very experienced breast surgeon,Dr. David Finkle, below, who has a different perspective.  You might want to think about a dual plane to lift your breasts, also.  See my web link below.  But now to your question!  Here are a few tips for you because this is perhaps the hardest decision for a patient to make, as well as the surgeon.  Also see the video attached to my answer.  We spend up to two hours for our BA consults to be sure there is careful communication. We do a full exam in front of a full-length mirror taking six exact measurements.    We put your photos on a large computer screen for imaging, and go over your “ideal-size” photos. We then save this information to your password protected “web account.”


     First and foremost the implant should fit the dimensions of your breast and tissue cover.  Balancing the implant to your over-all body shape and tissue cover is essential.    The main thing is to have the diameter of the implant fit the diameter of your breast "foot-print".  Higher profile implants tend to have a smaller diameter.  Higher is really a marketing term, but often translates into the same volume implant with a narrower base.  Saline implants actually tend to decrease in diameter as they are inflated!  The average size chosen over our last 7,000 breast implants was “350cc”.  BUT, 90% of our patients tell us they wish they were bigger a year after BA.  (We will see you every year for routine checks at no charge.) It’s like your mind incorporates the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc.  You can try on implants in the office by placing them into a special bra.  The implant is also flattened somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for flattening of the implant in the partial sub-muscular pocket.  Once you decide on a size you like, then add on 25cc, because in real life the implant will be flattened slightly by your tissues.  Multiple measurements need to be taken to fit an implant to your exact anatomy.  Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer.  Then you and your surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan.  Keep in mind larger implants tend to have more problems over the years.  Since silicone implants wrinkle less than saline implants, they might be your best bet.


     You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra.  Wear this around the house for a while, and see what you think.  Implant size must square with assessments of tissue cover, breast diameter, and chest wall width.  Multiple measurements of your chest wall are taken (seven in total).  Implant size selection has been an issue of much discussion.


     Therefore, I use a wide variety of methods, but the implant size is always established preoperatively.  Also, patients are advised to bring reference photos demonstrating their ideal size and shape.  A photo album of patient pictures is maintained to assist them.  These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery.  In determining the final size selection, I always place the highest priority on the preoperative measurements and potential tissue cover.  Finally, your verbal requests are factored into the analysis.


     We use the quick-recovery approach, so click on the web reference link below to have this explained and you can see the list of Quick-Recovery (Flash-Recovery or Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery journals.  It is a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs. It causes far less trauma to surrounding tissue than traditional approaches, and it dramatically reduces pain and recovery time. In published studies of BA patients, 95-percent of women interviewed after the procedure returned to normal daily activities within 24-hours. Quick-recovery BA is not a “gimmick.”  These specialized techniques, which actually speed recovery and get you back to your daily routine, kids and work, are published in our plastic surgery journals.  Because these PS journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science. Therefore, these are sound techniques, not marketing hype. 


     Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons).  Also, ask if the PS has an established, high volume breast augmentation practice, performing several hundred breast augmentations each year.  Be sure the PS has been in practice for a while, about 20-years might be a good gauge.  Does the PS offer all three incisions?  Discuss the implant type (gel or saline), shaped "gummy bear" or non-shaped, smooth or textured, implant pocket (over or under the muscle) and the "quick-recovery approach."  Ask to see their before and after photos if you didn’t see any on their website.  If they are experienced, they should have several 100 breast implant patients for you to view.  I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you.  You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center.  Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.      


All the best, “Dr. Joe”


 


 


Implants, some advices:

Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection. With volumes between 400-500 ml. 
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Respectfully,
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 174 reviews

Breast footprint helps to decide which implant to choose

Since everyone's body is different and our expectations are different.  It is not possible to choose the "correct" implant to use with just a photograph.  However, I will give it a whirl!

Based on the one photograph and the demographics given, I believe 600 cc will be OK, but I would choose silicone implants on top of the muscle.  This should "fill up" the loose skin and actually move your nipple position up about an inch, simulating a lift, without the lift scar.  An incision in the crease under the breast will be completly hidden and the right breast is slightly larger than the left, so different sized implants should be used.  The new silicone implants look and feel so much more natural than saline implants that I use them 95% of the time.  Saline implants wrinkle and ripple more than silicone and feel like a water balloon.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 73 reviews

Unsure of what size implants to get? (Photo)

Thank you for your question and photograph.  Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing an ASPS board certified plastic surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations.  It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like.  Best wishes!

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Unsure of what size implants to get?

Based on your photos, I don't think that an augmentation alone is going to look very good on you. You have significant breast ptosis or sagging. Adding an implant, no matter how large, will not elevate your breasts and your nipples will be pointing downwards. You can certainly have  an implant if you also have a breast lift to improve the shape of your breasts and elevate the nipple position, but 600 cc may be too large of an implant diameter based on what you look like in your picture-your breast fold sits high on your torso and a large implant will really bulge out on the top of your breasts

Breast lift with implants

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 wise pattern 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 wise pattern lift with an implant can result in a very nice shape if good technique is used.  The size 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.  

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 79 reviews

Unsure of implant selection

Hello, there are several ways to help select implants, such as trying on sizers, reviewing before and after photos of women with similar anatomy,  virtual imaging of the breasts to get a sense of the postop result, and so forth.  Your PS can assist with this process.

Unsure of what size implants to get?

Thank you for the question and pictures.  

 Although definitive advice would require in-person evaluation, I think that it is likely that you will benefit from breast lifting as well as breast augmentation surgery.  Based on your photographs, I would be concerned that you will not be pleased with the long-term outcome achieved with breast augmentation surgery only. 



Of course, breast augmentation/lifting surgery is a more complicated procedure (and more complication prone);  careful selection of plastic surgeon and careful communication of goals will be key.  Furthermore, you will need to carefully consider the trade-offs (such as additional scarring) associated with breast lifting versus the upsides briefly discussed above.



Generally speaking, patients undergoing this combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with will a significantly higher risk of complications and need for additional surgery.  Again, it will be important that you educate yourself regarding the pros/cons/risks/complications associated with breast augmentation/lifting surgery. Only after doing so can you make an informed decision whether or not to proceed. You will find a lot of information on this website and on the attached link.



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. For example, I have found that the use of words such as “natural” or "D or DD cup" 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, helps. Best wishes.

Ask about an augmentation mastopexy

Thank you for your question.

The implant has to fit YOUR body dimensions. The more you deviate from the proper fit (i.e., go too high, or too low), the more fake your breasts will look.

Surgeons use what 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.

To determine the final implant size, breast measurements need to be made:  base-width, breast skin stretch and nipple-to-Inframammary fold distance. The combination of these measurements will help determine tissue coverage and the required implant volume to optimally fill the breasts. If the skin covering your breasts is stretchy (>2 cm), or if your nipple-to-inframammary fold distance is greater than 9.5 cm, then more volume is needed for the optimal fill.

As such, with a base width of 15 cm, I believe 600 cc should be okay. I cannot say conclusively as an in-person exam would need to be done for precise and appropriate implant size determination.

I would like to add that since your nipple is pointing downward, it seems as though most of your breast tissue is sagging and hanging below the breast fold (inframammary fold). I could be wrong, but you may need a breast lift (mastopexy) to make the breast augmentation beneficial.

All this being said, share all your motivations for surgery, expectations and goals with complete honesty to avoid miscommunication and post-operative concerns/regrets. Be as specific as you can about what you like regarding your breasts and what you don’t like. 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.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 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.