I'm a 39 year old, 1 child,150lbs, 36d wanting 36ddd. My dr will not do more than 400cc under muscle saline or silicone. (photo)

I need a full breast lift, wanting very perky 36ddd. Did rice test & have compared pictures of women who are built like me (preop size and body structuring) who had 500cc and stayed the same size postop lift/augmentation. The surgeon said to calculate one loss of cup size due to the lift too. Afte rice test I was happy with 700cc size after considering a 1/2 to a cup size loss. Is this possible? I also read that under the muscle causes you to lose 10-20% of the look of the implant. So confused.

Doctor Answers 9

Implant Size for Breast Augmentation with Lift

Implant size is determined by the patient's anatomic starting point and aesthetic goals. It's always difficult to discuss cup size because it means different things to different people and is, therefore, a frequent source of confusion. For this reason, we utilize implant sizers to determine breast size in a more objective manner.

Your pictures definitely indicate that you need a breast lift procedure. This procedure can be combined with breast augmentation surgery when patients want larger breasts as well. Under these circumstances, safety should be everyone's first priority. When extremely large implants are utilized, the potential for secondary complications increases dramatically. For this reason, it's appropriate to stage procedures when patients want large implants.

In contrast, when patients want small to moderate sized implants, it's reasonable to perform these procedures together. This approach is associated with excellent clinical results, high levels of patient satisfaction and only one recovery.

If you're considering breast lift in combination with breast augmentation surgery, it's important to consult a board certified plastic surgeon. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

I'm a 39 year old, 1 child,150lbs, 36d wanting 36ddd. My dr will not do more than 400cc under muscle saline or silicone.

Breast augmentation with a lift would be a reasonable option just based upon the pictures, but an exam will be necessary to make a determination. Find an expert in breast surgery in your area who has great reviews and great before and after photos.

Kenneth Hughes, MD

Los Angeles, CA

Wants "very perky" 36DDD.

Thanks for including photos, and especially your goal photo. I believe this "dream post-op look" shows capsular contracture, and if you hugged that woman, her breasts would likely feel like croquet balls in her vest pockets. I can understand wanting that look (which is achieved with breasts of adequate size pushed up via a well-chosen brassiere). Any surgical breast lift striving for that degree of tightness will ultimately lose "perkiness" as the skin re-stretches under the weight of those large(r) implants. Your skin is already proven to be genetically stretchy by your need for a breast lift in the first place.

Nothing wrong with going big! You go girl!

Also, nothing wrong with wanting "as perky as possible." But very perky and that big may not be mutually achievable, and surgeons foolhardy enough to try both at one operation may well end up regretting it. And YOU cannot go back and have a do-over in cases of wound breakdown, ischemic skin death, or nipple loss.So consider what you ask for, and who you allow to try to achieve it, very, very carefully!

I'm with Dr. Blinski if these are really your goals. Have a full breast lift first and let things heal fully (I'd say at least 6 months rather than 3--the longer the better), after which you can choose the implant size you wish. That way your surgeon will have at least a fighting chance of getting you to the size and fullness required to come close to your goal photograph. I know it's two operations and a higher cost. But trying to do  this in one stage and failing will cost way more and may not have a safe re-do option. BTW, I almost always recommend breast lift and implant placement in one stage, and only a few of my colleagues require two stages for breast lift plus augmentation. But your requests push you to a different situation that must be made as safe as possible in order to achieve a satisfactory outcome as close to your goals as possible. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 240 reviews

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Wanting very perky 36DDD

Hello there.  I agree that in order to have perky 36DDD, you will need implants and lift.  Based on single-view of your photo and limited information, you may need 500-600cc implants to have DDD cup size.  As your plastic surgeon may have informed you, as you go larger in implant size, there is a higher risk for recurrent ptosis (sagging).  Best to review and understand all pros, cons, and limitations of breast implant and lift.

Augmentation and Lift

Thank you for your question and posting photos.   Your photo shows significant sagging that will require a lift. Your wish photo shows someone who did NOT have a lift.  It is not reasonable for you to think your final result will appear like your wish photo.   First, with a lift, you will need scars to achieve a much better form to your breasts and correct your sagging.  If you chose a simultaneous augmentation, there are some limitations on what size can be placed safely.  And remember, the implant will cause some recurrence of sagging.  One option will be to perform your lift first.  And then come back for a 2nd stage augmentation.   Please talk to a plastic surgeon to learn more about your options.

Dr. Basu
Houston, TX

Breast Lift with Implants

Hi Almost,
You have to manage your expectations as you may never reach your ideal.  No need for confusion. If you want to add a couple cup sizes, you are looking at a minimum of 400-600.  You arrived at 700, which if good because now you have a reference point.  I am not sure a lift looses a cup size.  I would have a hard time believing that women who put in 500cc implants stayed the same size (our average in the last ten years of over 5,000 implants is 350).  If you like 700, see if your dimensions and your surgeon agree.  Then go from there. All the best, "Dr. Joe"

I'm a 39 year old, 1 child,150lbs, 36d wanting 36ddd. My dr will not do more than 400cc under muscle saline or silicone.

In your case I would recommend two separate operations. First a full lift, than after 3 months healing a 700 cc implant. 

Large augmentation with lift

Determination of implant size is a personal decision.  If you chose an implant that extends beyond your breast base, you are going to have a less natural appearing breast.  Also, the larger the implant you chose in an augmentation/breast lift combined procedure, the higher the risk of nipple loss.  That being said, you should be able to pick your implant size after being informed the risks associated with the implant size you chose.  Good luck with your upcoming surgery!

Patrick C. Wilson, MD
Huntsville Plastic Surgeon
5.0 out of 5 stars 28 reviews

Picking a breast implant to meet your goals.

You definitely need a breast lift.  As far as an implant you can expect that for every 200 cc of implant volume you will go up one cup size.  It is important that the implant matches your breast base diameter.  Your plastic surgeon has the experience to attempt to meet your aesthetic goals and expectations.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 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.