Not sure if I should get 450cc; 485cc or 505cc silicone moderate plus? (Photo)

Dear Beautiful9091,
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

Many factors enter into a decision for the best implant in a given individual. A proper decision requires an in office physical examination. Take the requisite time to choose your surgeon then allow him or her to guide you through the process.This will allow far greater success than trying to chose the implant yourself using online opinions from surgeons with limited information.

Thank you for your question.  If your overall goal is to look proportionate and natural, there are many ways your surgeon will help guide you through this process.  For example, a thorough in-person consultation may including taking accurate measurements and assessing your overall skin tone which would allow the surgeon to recommend a range of implant profiles and sizes that suit your frame.  It is difficult to guarantee a specific cup size as each bra manufacturer has differing size standards.  Part of the consultation process may include trying on sizers.  This would give you a general idea of your size after surgery.  @yorkplasticsurgery

A board certified plastic surgeon will be able to guide you to the correct size breast implant for your measurements and desires.  Measurements of the chest wall and breast imprint width as well as knowledge of all breast implant sizes and profiles should make this process easy. If you want more volume, the implant profile can be shifted from a moderate profile implant to high profile implant.  Try on a profile bra of various implant sizes the PS recommends under a tailored blouse, tight sweater, swimsuit, 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.   Work your way up or down from that size (450 cc) to determine the size that boosts your self-esteem, and fits your anatomy.  Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision. Remember that there is no standardization of cup sizes between bra manufacturers.

We always recommend going with the bigger size implant size if you're having trouble deciding. Patient biggest regret is often not going big enough.

Thank you for your question and photographs.  I think you are starting from an excellent position and should anticipate a nice result.  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 additional ASPS board certified plastic surgeons to ensure that the implants you 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, but be aware the size difference among the three is not large.  Best wishes! 

Thank you for your question. I think that the most important issue at this point is finding a surgeon with significant experience treating tuberous breast deformity. They should have any before-and-after pictures of women they have treated with tuberous breasts. After you find a surgeon, there will be multiple points of discussion to help you decide how best to reach your goals. Again your surgeon's experience with your specific anatomy is the most important factor at this point. Good luck with the process.

The difference of 55ccs is small- little over 3 tablespoons or equivalent to about a 1/4 to a 1/3 of a bra cup size. I believe you could achieve your wish goal. I recommend an in person evaluation by a plastic surgeon to be measured and discuss your goals. After I measure and discuss goals with my patients, we then look at pictures of women with similar measurements with different size and style breast implants. My patients tell me that this process is very helpful in determining what size breast implant is right for them.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author                      
RealSelf Distinguished Hall of Fame Inductee

Great question!  The sizing you are looking at are at most 50cc's of change, this is very minimal and honestly will not make much of a change.  You can't go wrong with any of these, as long as the implants fit your chest diameter, as you probably will not notice much change.  Understand that approximately 200cc's is one cup size, so 50cc's is only about a quarter of a cup.  Implants do get smaller once they are inside the body due to the compression of the tissues so I generally tell patients to pick the bigger of the implants that they like.Best of luck and hope this information helps!
- Dr. Roger Tsai  @DrRogerTsai
Board Certified Plastic Surgeon

You and your Board Certified plastic surgeon must first diagnose the problem.   Once you and the surgeon agree that you have Type III tuberous breasts that require multiple decisions as to what type surgery and/or surgeries you will need, then you must decide if the appearance of your breast is more important than the size or vice versa.For instance, you have enlarged areola with breast tissue herniated into the nipple due to a weak dermal layer.  You could lower your inframammary fold and release the constriction of the lower pole of your breast. and potentially get a relatively large breast implant such as you have indicated by your wish pictures.  This larger implant will increase your chances of getting some level of cleavage.  On the other hand, you can reduce the size of your areola, force your breast tissue back into the breast and out of the nipple areola complex by doing a variation of the Benelli mastopexy (a lift).  In this scenario, either put no implants in and do the augmentation as a second surgery or you could put small implants in.As you can see from all the above plastic surgery mumbo jumbo, long before you decide on which size large implant you need, there are a whole bunch more important decisions to be made to correct your complicated Type III tuberous breasts.At this juncture, you need to find plastic surgeons in your area who have demonstrated expertise in dealing with tuberous breasts, and then decide which one of them matches your personality and anatomic needs.