I went for a consult today- We decided on 440cc saline implants under the muscle...(Photos)

Question

I am currently a large A cup - small B cup. I am 5'4 & 115lbs. I know it is impossible to correlate cup size with implant size but any insight would be appreciated. I want them fuller, larger, but not over the top; not past a C cup. Now that i am home from my consult and researching 440cc saline seems rather large for me. Should i go smaller? Should i go over the musle? Any insight is appreciated. Thanks!

Jeffrey M. Darrow, MD · Answer

You mentioned you wanted "fuller, larger, but not over the top and not past a C cup".  I believe 440 cc implants will put you well into the D cup range.  At 5 feet 4 inches, 115 lbs, I believe you will find a implant volume between 275cc up to 375cc will allow you to achieve what you want.  Important considerations are: 1) how wide your breasts are and the distance from your nipple to the fold under your breasts under full stretch.  If you choose an implant whose measurements exceed those measurements of your breast, the boundrys of your breast, such as your natural fold under your breasts, must be divided to fit this larger implant and this will result in an unnatural appearance and potential future problems.  I use 2 methods to help patients determine what would fit them best and give a proportional increase in breast size.  A 3-D system called Crisalix allows scanning of your breast dimensions and then allows virtual 3-D visualization of what your breasts would look like with different implant sizes inside.  Several simulations can be compared side by side to see the subtle changes from one implant size to the next.  I also have multiple implants patients can try on under their clothes and look in the mirror to give them an idea of what can be achieved.  For the most natural appearance I always place implants under the muscle and the vast majority of my patients use silicone implants as they have the most natural feel and appearance, especially in slimmer patients.  Seeking other  opinions may be helpful. Always see a board certified plastic surgeon.

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

#RealSelf100Surgeon

#RealSelfCORESurgeon

Christopher J. Davidson, MD, FACS · Answer

Thanks for the question and photos.  To determine if you "like" this size, we use a couple of different techniques.  A new technology we have is made by Crisalix and allows us to "scan" a patient and then show you what you would look like with different implant sizes.  Then you can put on virtual reality glasses and truly see your new breasts in 3D.  Although this is very new technology patients have found it to be very helpful in determining a size.  And then we also use the old fashioned method of trying on implants in a bra.  In my humble opinion 440 cc will definitely take you past the C cup range and well into the D cup range.  My advice is to always place the implants below the muscle and truthfully more people choose silicone gel implants due to their more natural feel and look.Probably worthwhile circling back to your plastic surgeon or visiting another since I fear that you might find 440 cc ultimately to be "over the top!"Best of luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  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.  This entire surgery
can be performed with a small incision technique.  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.   
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Christopher V. Pelletiere, MD · Answer

In choosing the correct implant, your surgeon's job is to take measurements and see what will work best for your breasts/ frame. The goal is to then merge this with your overall goals.  Without an examination, it is impossible to say what will work best for your frame, but if your surgeon measured you and felt that those dimensions would work well, then I would go with what is recommended.  The one thing I would caution though is using a saline implant.  The silicone gel implants are more durable, feel more natural, and are equally as safe as saline implants.  95% of my patients go with the silicone gel implants and are happier long term then saline implant patients.  I would discuss this with your surgeon before proceeding or go for a second opinion.  I hope this helps.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. Unfortunately, online consultants will not be able to provide you with specific enough advice (regarding specific breast implant size/profile) to be truly helpful.  ***I would suggest that you spend more time with your plastic surgeon communicating your goals carefully.I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction) is also decreased with implants placed in the sub muscular position. On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  that can be seen with breast implants placed in the sub muscular position.  Make sure that you also learn about the pros/cons associated with the use of saline versus silicone gel breast implants as you make your decisions. You will find a lot of information on this website, and on the attached link as well.

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 are 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. In bra sizers can be useful communication tools also. I have found that the use of words such as  "over the top” or "C cup" etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  The use of computer imaging may be very helpful during the 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 ( after the use of temporary intraoperative sizers).

I hope this, and the attached link (dedicated to breast augmentation surgery concerns), helps. Best wishes for an outcome that you will be very pleased with.

I went for a consult today- We decided on 440cc saline implants under the muscle...(Photos)

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