What size implants should I choose? I'm 5'4", 140lbs. I'd like somewhat of a natural appearance, mostly to add fullness.

Hi D,It sounds like you are seeing a good surgeon who is using "dimensional analysis" to help you with sizing.  That is great!This is perhaps the hardest decision for
a patient to make, as well as the surgeon. 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.Approximately 50 cc (1-2 oz.) is added to the final volume to account
for flattening of the implant in the partial submuscular pocket. Once you
decide on a size you like, then add on about 25-50 cc, 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. Then, the patient’s verbal requests
are factored into the analysis.Our
average size over the last 6,000 implants was 350. 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 they
have an established, high volume breast augmentation practice, performing
several hundred breast augmentations each year. 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”

Hi and thanks for your question. There are numerous ways to size a patient for appropriate shaped and volume implants so as to achieve a natural appearance with increased breast fullness and projection. I am a strict advocate of dimensional planning, primarily relying on the base width and height of the native breast. Once the width and height of the appropriate implant has been chosen, it is a matter of sizing to decide upon your ideal breast/ implant projection. I prefer to use customised gel sizers under a tight T shirt to help with this decision. Once you have this final dimension you would have automatically selected a narrow range of implant volumes designed to suit your specific chest dimensions and give you the shape you want. In your particular circumstance there are numerous other volumes possible between 320 and 440cc to choose from. It is a matter of altering the profile slightly and/ or considering a different implant manufacturer. Your specialist Plastic Surgeon can expertly guide you through this process. You'll be in good hands. 

Hello! Thank you for your question. In general, implant size does not correlate with bra cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory (e.g, implant type, incision, placement, lift, etc). I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Hope me that this helps! Best wishes for a wonderful result!

Selecting a size is always a difficult thing.  This can only be done in person during a consultation.  A method that has worked well for me over the past 20 years is this:  1) we have specially made "sizers" that we put in patient's bras that simulate what an implant would look like.  This is far superior to just putting a bag of rice or an actual implant in your bra because this has a shape that can conform to your breast shape.  2) we have extensive discussions as to the patient's desired result and final shape  3)  we have patient's select a photo of a woman who is the size she is hoping to achieve.  With this method, we have been over 99% successful in delivering the desired result.  If you don't feel comfortable with your surgeon's recommendations, it would be best to voice your concerns before surgery.  If you don't feel that your PS is listening to you, it may be time to get another opinion.

It is really difficult to discuss implant volumes with you without performing an exam. That being said, you can always do a  baggy test to get an idea with the volume that you looked at.

There are several factors that plastic surgeons consider when recommending implant sizes. I consider two factors when selecting implants for my patients:1. Dimensional planning2. Gel Implant Sizing systemDimensional 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. BasuHouston, TX

I believe, as most people do, its much more important to choose the right surgeon then the right implant.  There are many implant options available, 320 cc, 440 cc, and many in between.  Also different shapes, projection, material, and companies.  "Wish photos" are helpful.  Some preop photos of your own would be helpful, but an online evaluation is very difficult and the decision of which implant to choose should be made during a face-to-face consultation.

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 suit
at a preoperative visit will help you and your surgeon choose the optimal
implant.

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

Thank you for the question.  In regards to specific size/profile of breast implant, despite good intentions, online consultants will not be able to provide you  with  meaningful specific advice.  Careful measurements, dimensional planning, and careful communication will be key.
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.  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" 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, viewing the patient's breasts in the upright and supine position, are very helpful during the breast implant selection process.
I hope this, and the attached link, helps.  Best wishes.

That is a very large size difference that is suggested by your plastic surgeon and it confuses me.If you have a proper breast implant sizing system evaluation and you felt 320 cc was too small then increasing to the 400 cc range might be an excellent option for you based on your breast base width.For more information on how to choose implant size please read the following link: