Choosing the right sized implants: how to choose the right size for patients who already have a lot of breast tissue/breast fat?

Trust your surgeon in what she or he advises.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Cup sizes are not standard across bra makers, and implant sizing is NOT based on height, weight, BMI, or desired cup size.  This is something you will need to do IN PERSON with an experienced surgeon to determine what works well for you, and to get advice about if what you like is possible and what to expect with regards to results.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.  

It is very difficult to determine the best size you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implant
#toobig #breastimplant

Thank you for your question.  You are not alone in your concern about implant selection and questioning how you can feel most confident with your choice going into your procedure.  What I have found over my many years of practice is that the best aesthetic outcome is the result of careful planning and clear communication with regards to patient goals, expectations and any limitations in achieving a patients goal.  To help achieve this I routinely use 3D imaging with our Vectra system and physical implant sizing in my practice to help patients see what they will look like in a variety of implant sizes, shapes and profiles.  While this imaging is never 100% accurate, it does provide a patients with a pretty realistic idea of what they can hope to achieve and I have found that it helps .  Without seeing you in person it is difficult to say whether or not a 250cc implant will provide you with the result you are hoping for but I would encourage you to discuss your concerns with your chosen plastic surgeon because you should approach your surgical date with great confidence and excitement.    I hope that you find this helpful and I wish you all of the best!

Search for board certified plastic surgeons who perform hundreds of aesthetic breast procedures each year with favorable patient feedback and hundreds of before and after photos on their websites.  Select a couple and schedule consultations with them.  They will be able to guide you to the correct size for your measurements and desires.  Measurements of the chest wall and breast imprint width as well as knowledge of all breast implant sizes and measurements should make this process easy.  The difference between these sizes is difficult to appreciate, and you should pick the one you like better.  
Try on a profile bra with the sample silicone and saline implants under a tailored blouse, tight sweater, swimsuit, and other garments you typically wear so that you have the best idea of whether the garments fit as desired with the implant selected.  I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy.
Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA

In my opinion the best way is to try on a sizing system made specifically for this very purpose.  You can do this in the office of your plastic surgeon.It is important to realize that the ultimate breast size and shape depend upon so very many variables.  A 300 cc implant on a petite woman with a thin frame may look quite large, but that same implant in an overweight woman may be barely noticeable.  Size and shape of the result depend upon the volume of the implant, the shape of the implant, if it is over or under the muscle, your skin and its resilience, stretch marks, the degree of breast sagging, chest circumference, amount and distribution of the natural breast tissue, etc.  For this reason, it is impossible to give reliable advice based simply upon height and weight, or even photos. The only way to approach reliable predictions is with an in-person examination with a board certified plastic surgeon, the use of sizers, 3-D imaging, and most importantly, relying upon the skill, expertise, and experience of your chosen  Board-Certified Plastic surgeon.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Thank you for your question and photographs.  Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing an ASPS board certified plastic surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations.  It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like.  Best wishes!

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.
With regards to your specific question, without measurements it is difficult to offer any reliable sizing advice. There is also no guarantee despite the myriad of sizing tools at your surgeon's disposal. Your best option is to take into account all of the sizing aids available to you and choose a device which fits your unique measurements. That is the best way in which to avoid the dreaded "fake" look. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.   A breast lift with an implant can result in a very
nice shape if good technique is used.  The size, profile, and shape of
the implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Hello The type and size of implants that you want to obtain will determine you with the plastic surgeon of your choice, that according to your figure you will be told which implants fit your body well, the shape can be tear or round, Your surgeon will recommend.The teardrop-shaped implants are contoured and considered more anatomical. They are shaped like a natural sinus and create an inclination when placed over the chest muscles. Although these are more natural looking breast implants, you will need an experienced plastic surgeon to ensure they are properly positioned.
Round breast implants are used to give women a "Victoria Secret" appearance. Round implants are the most common breast implants as they provide a fuller and fuller look as well as a better cleavage. Certain types of round implants can also improve breast projection. However, some women feel that round implants look too artificial.

Always To serve you, Dr. Manuel Ventura Certified, Medical Research Institute of Plastic Surgery in Sao Bernardo do Campo, Sao Paulo, Brazil.