Dear Ms. Boss Lady from that 323, Thank you for your story, questions and photos. Nothing substitutes for a personal evaluation and a face to face discussion of your options. Many factors need to be taken into consideration than just your desired breast volume. Unfortunately without a exam of your tissue and measurements I can give you general information that I hope you find helpful. Your final desired breast appearance is a combination of your current breast appearance, size, shape and location of the implant chosen There are many decisions both you and your Plastic Surgeon needs to make. Based on your photos, my answer to your specfic questions are: 1) I in general prefer that implants be placed under the muscle (dual plane) because of the lower incidence of capsular contracture and the coverage the muscle provides. 2)I would advise round silicone gel filled implants (the profile to be determined by your chest measurements: see below) 3)Volume size to be determined as described below 4)the inframammarry incision is associated with lowest rate of post operative capsular contracture. 5) At your preop appt. and on the day of surgery bring several model photos of what you want your final breast appearance to look like Your final decision should be based on personal consult with a Bd. Cert. Plastic Surgeon who will examine you and go over that which is best for you. The following are some of the topics you may want to discuss and why. General overview of your choices and discussion points: IMPLANTS 1) normal saline fill vs silicone gel fill 2) profile: low profile to high profile (choice based on chest measurements) 3) shape: form stable vs round PLACEMENT OF IMPLANTS 1) sub pectoral, dual plane + less chance for internal scarring (capsular contracture) + padding from the muscle therefore less chance of implant palpability (rippling) - varying degree of animation upon pectorals major contraction ( breasts moving) - longer immediate recovery 2) supra pectoral + in borderline ptosis (breast sag) can provide alternative need for mastopexy + faster immediate recovery + animation upon contraction of pect. muscle is nil - increase chance of internal scarring (capsular contracture - increase potential for breast implant palpability (rippling) ACCESS INCISION 1) periarolar 2) inframammary 3) axillary BREAST MOUND 1) symmetrical 2) equal size 3) breast fold location NIPPLE/AREOLAR POSTION 1) normal 2) high 3) low 4) symmetrical 5) too large SKIN QUALITY 1) stretch marks 2) thin skin 3) elasticity SIZING is a very personal choice 1)implants come in "cc" sizes not cup sizes 2) 30 cc 1 ounce 3) purchase a full bodied, non padded bra and take a nylon stocking and fill until you reach the desired size you desire....measure the volume using a measuring cup and convert to cc's. 4) If implants placed under the muscle I usually recommend adding 10% to measured volume to compensate for the flattening affect of the subpectoral placement COMPANIES I personally choose the company that the breast implant base measurements and match to the patients chest measurements. Sientra only makes Silicone Gel filled implants. Ideal only makes Normal Saline implants (with internal baffles). Allergan and Mentor make both silicone gel and Normal Saline filled implants. 1)Allergan 2)Mentor 3)Sientra 4)Ideal Please bring several model photos of your desired breast appearance and a list of questions to your consultative appointment and make sure your Plastic Surgeon is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery). Best wishes, Dr. R. A. Hardesty, MD, FACS Diplomate and Certified by the Am. Bd. of Plastic Surgery Awardee:RealSelf top 100 wwwimagineplasticsurgery.com 4646 Brockton Ave Riverside, Ca 92506 (951) 686-7600