Does the plastic surgeon ultimately let you choose what size of cc even if its not what they recommended?

Question

My ps said 300cc or 325cc. I currently wear 32c from Victoria Secret which is the only place I get my bras from and they measure bigger Ive heard. I want to come out with a full D cup or I wont be fully satisfied. I read somewhere that if you want to increase from an A cup to a B cup it will take 200cc breast implant but a full B cup may take 250cc. If youre a full B cup and want to enlarge breasts two cup sizes then you will need at least 300cc-400cc. Is this correct?

Joe Gryskiewicz, MD, FACS · Answer

Hi K,I believe you have received good advice.  I agree, it is in general 200 cc for each cup size.  Be aware VS "over-sizes" bras.

Here are a few tips for you because this is perhapsthe 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 consultsto be sure there is careful communication. We do a full exam in front of afull-length mirror taking six exact measurements.    Weput 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 patientsthat 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 forflattening 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 yourtissues.  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 surgeoncan piece together the puzzle by matching your measurements, with your wishes,versus your tissue cover and the available implants to arrive ata surgical plan.  Keep in mindlarger implants tend to have more problems over the years.  Since silicone implants wrinkle less thansaline implants, they might be your best bet.

You canalso approximate this at home by measuring out an equivalent amount of riceplaced into a cutoff foot of old panty-hose, and put this in your bra.  Wear this around the house for a while, andsee what you think.  Implant size mustsquare with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wallare taken (seven in total).  Implant sizeselection has been an issue of much discussion.

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

We usethe quick-recovery approach, so click on the web reference link below to havethis explained and you can see the list of Quick-Recovery (Flash-Recovery orRapid-Recovery) Breast Augmentation articles from peer-reviewed surgeryjournals.  It is a surgical procedure thatuses special instruments and techniques to minimize tissue damage and avoidtouching the ribs. It causes far less trauma to surrounding tissue thantraditional approaches, and it dramatically reduces pain and recovery time. Inpublished studies of BA patients, 95-percent of women interviewed after theprocedure returned to normal daily activities within 24-hours. Quick-recoveryBA is not a “gimmick.”  These specializedtechniques, which actually speed recovery and get you back to your dailyroutine, 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 sureto see only a board certified plastic surgeon (by ABPS - The American Board ofPlastic Surgery) who is a member of ASAPS (The American Society for AestheticPlastic Surgery) and or a member of ASPS (The American Society of PlasticSurgeons).  Also, ask if the PS has anestablished, high volume breast augmentation practice, performing severalhundred breast augmentations each year.  Be sure the PS has been in practice for awhile, 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 theirwebsite.  If they are experienced, they should have several 100 breastimplant patients for you to view.  I would also recommend that your doctoroffer you the chance to talk to past patients who would be happy to discusstheir experience with you.  You need to feel comfortable, so make sure theenvironment is safe as in an accredited surgery center.  Also, ask a prospective surgeon if he or shehas ever published journal articles in professional peer-reviewed journals,which they can provide you.      All the best, “Dr. Joe”

Richard H. Tholen, MD, FACS · Answer

Golly, you've cast your question as if it is a choice between your wish and his/her recommendation! You're overthinking this!Your job is to accurately convey your goals to your surgeon, and then let the expert best choose how to achieve your desired outcome, which should not be letters (cup sizes, which are all different by different manufacturers as you accurately noted) nor cc (which most women are NOT comfortable or intuitive in discussing). It's what implants plus what the patient's own breasts 'bring to the party" equal the desired "look." For an "average" size woman (say, 5' 4" and 120 lbs), it will take about 200-250cc to equal one bra cup size, depending on where you buy your bras. For 4' 11" and 93 lbs, it may take less than 200cc.But that's why it is so important to convey your goals, better in  photos than in letters. And to have a frank discussion about redo surgery costs if you end up wanting a different size than everybody initially agrees upon. The surgeon's goal is to make you happy, not to get you to comply with his/her wishes or recommendation. But you have to walk that fine line between trying to "do this" yourself and actually trusting your chosen professional. After all, s/he's done this a few hundred or thousand times, and you've done this . . . right, nada. So while being you're own advocate and second guessing your surgeon's advice is all fine, have you really had the discussion, looked at goal photos together with your surgeon, sized with implants in a bra or stretchy top, and then had MORE discussion.Now, having said all of that, and assuming you are "average" height, weight, and "full B is really "full B," I think you ARE closer to correct at 400cc than your surgeon at 300 or 325cc. Depending on more of that discussion and seeing goal photos and sizing data, I might even recommend 450cc or more. Realize the differences between 300 and 325cc sizes SOUND large, when in fact 25cc is LESS than 2 tablespoons. And the difference between 325cc and 400cc is 2 1/2 ounces (5 tablespoons). Put 5 tablespoons of water into a drinking glass and try to visualize just how much breast volume that would add. (ANSWER: not that much. In fact, barely visible.) So keep your perspective. Too many plastic surgeons will "add an implant size" thinking it will make a visible change, when in fact it takes about two implant sizes to equal the least visible change.A lot of sizing accuracy depends on your present height, weight, and actual breast size and careful measurements. That's what an ABPS-certified plastic surgeon's job is. Perhaps you need more discussion, or even another consultation or two elsewhere. It shouldn't be a "battle;" it should be an agreed-upon and comfortable collaboration! Best wishes! Dr. Tholen

Nelson Castillo, MD · Answer

Ultimately the implant sizing is up to the patient assuming that they understand all of the risks and benefits of a particular size implant, especially in relation to their anatomic starting point - breast base width, chest width, cleavage, amount of breast sagging, etc.  I would recommend seeing an ASPS board certified plastic surgeon in consultation.  They can help you select the appropriate size implant to help you approximate your goal appearance.  Hope this helps.

Laurence Weider, MD · Answer

I think you have brought up an important question.  That is, who makes the final decision regarding the implant size that is chosen?  Every Plastic Surgeon has his or her own philosophy about this, but I will give you my perspective.  I think it is best treated as a group decision between the surgeon and the patient.  In my practice, my cosmetic consultant and I spend a good deal of time talking to the patient during the initial consultation trying to determine exactly what her goals are. Looking at "goal" photos helps us to understand what she is looking for.  I stress to them that a specific size gives each person a different result.  For example a woman who is 100 lbs and 5'0" tall will get a very different result with a 300 cc implant than woman who is 150 lbs and 5'9" tall. For this reason, I don't think that the calculations that you mentioned are very accurate.  During the exam, I take several measurements that help me determine which implant sizes will fit best for that individual. By that I mean which implants will provide a natural result while minimizing the risk of short or long term complications.  In general, women who have had children can accommodate larger implants than women who haven't, because there skin is less tight. We then assist the woman in "trying on" sizers with a bra to see what look they like.  Assuming a woman wants an implant size that is larger than what I recommend, I will review the increased risks associated with their choice.  This usually includes an increased risk of numbness or pain as well as an increased risk that the implants will move out of the ideal position over time.  In general, I will allow them some leeway, however if I feel that an implant is so large that it puts her at increased risks of a bad outcome, I will not agree to using it.  It is best to have an in person consultation with an experienced, board certified plastic surgeon in your area.  Best of luck.

Farah Naz Khan, MD · Answer

It's hard to determine your best implant size without specific breast measurements and an in person exam. Remember to choose a board certified plastic surgeon who actually takes the time to measure you and examine your breast pocket. The goal of breast augmentation is to optimally fill your breast pocket, not to overstuff or understuff it. At my practice, we utilize a series of 5 breast measurements that help me determine the implant size, which in turn helps me deliver a 24 hour recovery. Do your research and choose a surgeon who takes the time to sit down with you and discuss your goals/expectations to determine the best size for you. Remember that sizers will only give you a rough estimate. Good luck!!

David J. Wages, MD · Answer

Thank you for your question.  In my practice the patient makes the final decision after evaluation and recommendations by the surgeon.  An experienced surgeon is going to base the recommendation on years of judgement and more than likely get the result.  A patient without any surgical experience is making a judgement base on emotion and hearsay from friends, family or the internet.  The best outcomes occur with a team approach of an educated patient and experience surgeon who will take the time to teach and show the patient the facts.  A patient may not understand the risks or tradeoffs of every choice and it is in my opinion the job of the surgeon to educate and help the patient to understand what they want and what the tradeoffs for this is.  I would recommend a face to face consultation with a Board Certified Plastic Surgeon who has experience in breast surgery. During your visit your surgeon should be evaluating your health to determine if you are a good surgical candidate and examining your tissues to get a sense of what type of procedure your tissues will allow. Only with a hands on exam can this be determined. Once an exam and opinion is rendered then you can decide if surgery is right for you. Good luck.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance.  Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the top (upper pole fullness).

Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.

These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.

Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

Director-Beverly Hills Breast and Body Institute

#RealSelf100Surgeon

Benjamin Van Raalte, MD · Answer

The way I help the patient choose an implant size is as follows:I take the width of the chest, that determines the implant width. Sometimes we can go up one width if the patient does not feeling the side of the breast and wants larger.The projection is determined by several factors. The patient's desired size. The elasticity of the skin. If the patient has not had children, and the skin is tight it may limit what it can fit. Larger than what might stretch could lead to a displaced implant or not as good an appearance. I usually state that there is a point where it may be larger but not look better.On the other hand if the patient has droop or sag I might encourage them to go larger to fill the skin envelope.A loose rule of thumb is indeed 200 cc is one cup size. But a patient with a wider chest it will not do as much with someone with a narrow chest. If the breast is 15 cm in width vs 12 cm in width, it would take 25% more in size to look the same. 400 roughly in the average patient is two cup sizes. Victorias Secret is usually a larger size than others a  medium C in other bra companies may be a D in VS. That way if you buy their C you feel bigger as they push you up. Many women are not in the correct bra size though. And your 32 would indicate a narrow chest.I have the patients try on the sizers, and do computer imaging. Almost always the patient decides but they may have had my explanation to help them choose the final size.If you are uncertain get a second opinion. I have seen many patients whose first surgeon told them 300 cc, and they were disappointed and I measured them and stated a 500 cc would fit if that is what they want. My reoperation rates for wrong size are very low.

Tom J. Pousti, MD · Answer

Thank you for the question. There is no accurate correlation between size of breast implant and cup sizes achieved. In other words, I do not think that the generalizations that you mention in your post are accurate enough  to be helpful for specific patients' care.

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're 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. I have found that the use of words such as  “natural” or "full 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, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size.

The use of computer imaging technology may also be very helpful during this communication process.

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. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.

I hope this (and the attached link) helps.

Does the plastic surgeon ultimately let you choose what size of cc even if its not what they recommended?

Answers (9)

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