Will 400cc be too large for my frame? 5' and 110 lbs. (photo)

Question

My chest measured in at 9 inches and I am looking at ultra high profile silicone under tissue implants at 400 cc and they measure 10.4 inches. My doctor originally said up to 350 cc but changed his mind this last consult saying 400 would be doable. I am 27 years old, with two children and not even an A cup right now. I'm two weeks out from surgery and need to decide. Would this be wise? Are there any problems you can foresee?

Caner Kacmaz, MD · Answer

i  would recommnd you to have normal small size because you have thin skin. 
Breast implants are sized according to their volume in cubic centimeters (cc).

How do you know what size implant to choose? Looking at pictures and talking to friends who had a breast augmentation might help.

Off course the volume will depend on the shape and size of your actual breasts, your frame and the size you want to achieve.

Our plastic surgeon will advise you thoroughly. Bringing pictures of a desired restult to be shown to our surgeon, might be very helpful.

Kenneth Hughes, MD · Answer

Breast implant size has nothing to do with bra cup size - which varies with each bra manufacturer. The average implant volume placed in the US is 350 cc. A very general estimate is that one cup size is 150 to 200 cc of volume, but realize that no direct correlation exists between the two.
A board certified plastic surgeon will be able to guide you to the correct size implant. Based upon measurements of your chest wall and breast imprint width as well as knowledge of all breast implant sizes and profiles should make this process easy. Try on a profile bra with various silicone cc sizers your PS recommends under a tailored blouse, tank top, bikini, workout clothes, and other garments you typically wear so that you have the best idea of whether the garments fit as desired with the implant selected. Select the size that boosts your self-esteem, and fits your anatomy.

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

Elisa A. Burgess, MD · Answer

I have many patients with this scenario in my practice. We talk a lot about how they will "wear" the implants every day. Are they active? Do they work out or run a lot? Because the implants do have some weight and the skin can stretch out if they are too big. So a larger 400 cc implant can be done for all the right reasons. But once the skin is stretched out further, it makes it harder to downsize. We use 3D imaging in our practice and it is called Crisalix. It allows patients to virtually try on implants to see what they might look like after surgery. We also do traditional sizing. Make sure to go to a plastic surgeon that is board certified and does a significant amount of breast.

Scott W. Vann, MD, FACS · Answer

Yes I think 400 is probably too large for your frame. You are only 5 feet tall and have a very slim frame. I think 350 is probably the upper end of what you should use. 300 to 325 would be more ideal. Also I would recommend submuscular placement which would give you a more natural result and has less complications. Good luck.

Gary M. Horndeski, MD · Answer

400 cc implants will not fit under the muscle and will extrude inferior and laterally. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants can be place totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Caring423836,
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

Donald R. Revis Jr, MD · Answer

Good morning!
You can absolutely fit that size, but the best way to determine if this is the correct choice is to visit your PS office and try on the implant sizers with several different tops- that way you can make sure what size will best achieve your goals!

Ram Kalus, MD, FACS · Answer

Thank you for your question and photo. As you undoubtedly know, a precise treatment plan or specific implant recommendation can only be determined with a careful examination and detailed discussion with your plastic surgeon. My word of caution to you is that with the Ultra High Profile implants there is a tendency for those implants to flip because they are relatively narrow and act like a spherical ball.

Volume (300 versus 400), is far less significant than implant width and projection, as you already alluded. Implant width is similar to shoe size. The implant literally needs to fit into your breast and chest. The 350 Moderate Plus may well “fit” your breast, but the volume and projection are what will determine the “look” you want, similar to the style or type of shoe you would select. It is true that for a given volume a high profile implant will have a narrower diameter, and it is also true that a person such as you with a petite frame will require a narrower diameter implant than a patient with a broader chest or larger frame.  Other considerations such as saline versus silicone are also important, as are "round" versus "anatomical" or "form stable" or "shaped", smooth surface versus textured, and softer versus firmer with the different levels of gel cohesivity.

By the way, the term “natural” can mean different things to different people and the UHP implant tends to give you a more fake “augmented” look. You can certainly achieve a “natural” appearing result with a high profile implant if properly selected, but as a rule, the larger the implant and the higher the profile, and certainly if the implant is positioned too high, the greater the chances you will look “augmented” because of exaggerated upper pole fullness or convexity.

In my practice, besides a thorough interview process and physical examination with careful measurements, we use on lay sizers within an unpadded bra to help you understand what you are likely to look like in a bra, bathing suit, or T-shirt with a given size implant. In addition, and this is critical, we ask all of our patients to provide us with photos of their desired final look, with images of women’s breasts that most closely resemble the look they are trying to achieve. This serves as a visual guide that thankfully rarely leads us astray. The most common reason for patient disappointment after breast augmentation is size-too big or not big enough. This algorithm which we have been employing for over thirty years has proven to be very successful.

Because all of these factors can leave you quite confused, it is crucial that you select an experienced board certified plastic surgeon whose aesthetics align with your own, and with whom you feel comfortable. Don't be reluctant to seek a second or even third opinion if necessary to be sure and feel confident about moving forward with scheduling surgery. Expressing your desired cup size is notoriously inaccurate, and final breast size is the most common reason for patient disappointment after breast augmentation, either too big or not big enough.

Take your time, do your research. Best of luck to you.

Connie Hiers, MD, FACS · Answer

Based on your one photo, the 400 cc implant will be a large implant for your tissue and frame. I would suggest going with something a little smaller than will look more natural.