5’3” 134lbs. Natrelle SoftTouch 445cc moderate profile enhanced look - Am I choosing the right implant? (Photos)

Question

Hello I am 5’3” 134lbs breast is 14.5cm and was recommended I get the Natrelle SoftTouch 445cc moderate profile enhanced look implants. For reference I am a runner and would like big boobs but not anything disproportionate to my body. Am I making the right choice or will I regret not going a little bigger? I also measured nipple to nipple and it’s 9 inches. I don’t want a big gap in the middle.

Daniel Barrett, MD · Answer

Dear Htx211,

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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Donovan Rosas, MD · Answer

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing.  Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.  
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." Communication is key as you and your surgeon create your custom surgical plan. 
With regards to your specific question, implant choice will not necessarily change the gap between them. Wider devices to a degree can help with this. Given your measurements, you do have room to upsize and go wider should you choose to. However, this will lead to greater volume which may not be your goal.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Gary M. Horndeski, MD · Answer

Your breasts are low on the chest wall and laterally displaced. You would benefit from a breast lift. If you do not do a breast lift then the implants have to be centered underneath the nipple-areola complexes. This will require the implants to be placed low, the inframammary fold may have to be released and the breasts will bottom out inferiorly and laterally. The breast lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desire.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Mats Hagstrom, MD (license on probation) · Answer

Breast augmentation outcomes are generally based on three variables.
The first is the patient’s candidacy for the procedure which varies from person to person.
The second is implant selection in regards to shape size and type.
The third variable is the surgeon’s ability to do the procedure correctly, or placed the implant in the correct position.
Each plastic surgeon has their own way of guiding patients through the implant selection process.
Some plastic surgeons ask the patient to make the final decision stepping out of the equation in regards to taking final responsibility.
Some plastic surgeons make the final decision based on input from the patient.
 My personal preference is to work with before and after pictures of previous patients who had similar body characteristics.
We do this until I feel I have a very good understanding of what the patient is hoping to achieve.
I typically bring appropriate pictures with me to use it reference during surgery.
During the procedure I used temporary implant sizes to determine what size and shape implant. It will give the desired outcome.
 I typically have a full selection of implants available to me during surgery.
This is worked well for me.
Using excessively large implants will generally always lead to an increase rate of undesirable side effects, complications and need for revision surgery.
It’s true that many women wish they went bigger, but it is also true that as they do, the chance of having problems goes up at
Best,
Mats Hagstrom MD

5’3” 134lbs. Natrelle SoftTouch 445cc moderate profile enhanced look - Am I choosing the right implant? (Photos)

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