Maximum size for fake look on small frame? (Photos)

Question

5'1", 115 lbs, bwd 11cm, n-imf 6cm. I've breastfed one child and intend to again in 4 or more years. I lift weights - crossfit, powerlifting, bodybuilding (bikini competitor). I like the big fake look, I don't care much about looking "natural" but I still want to look aesthetically pleasing. I want silicone implants, if I had enough tissue I'd prefer subglandular placement to prevent animation deformity from lifting, but I understand I don't have much tissue. How big can I go?

Stefan Mark Szczerba, MD · Answer

From the Mentor catalog I would recommend Smooth Round High Profile extra.  I would keep the diameter closed to 10-10.5cm for subglandular so depending on your style preference I would say 260cc to 335cc.  Additionally I would fat graft a bit to address that transition to the rib on the left inner breast.  Subfascial with a little Galaflex mesh actually may be a good option also.  Best Wishes!!

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 and style 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 size and style breast implant is right for them.  Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Jacqueline Rose Makerewich, MD · Answer

Technically, you can go as big as you want. But at some point, you go from big to silly. Beaty is in the eye of the beholder, so you just need to keep in mind the limitations of this procedure. As you go bigger, you go heavier and your breast implants can bottom out. Your skin will get stretched and thinned out risking other complications. I also notes that your left breast is smaller and has a different shape, which is something you should discuss with your surgeon and understand the implications on the outcome.

Gary M. Horndeski, MD · Answer

Your breasts are asymmetrical in volume, shape, position and widely separated. 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, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

George Volpe, MD · Answer

To determine the maximum size a number of factors play a role. This includes pre-existing breast tissue, base width, the amount the inframammary fold needs to be lowered and also the distance from the nipple to both the fold and also to the collarbone. There is no exact maximum number however as one gets into the larger implants, the larger the implant, the higher the chance there may be a postoperative issue including malposition, symmastia, bottoming out among others. The photos of models provided have more starting breast tissue skin than the patient photos provided. If a very large size is desired, sometimes a second augmentation after a first augmentation allows a more progressive increase in size. In general, in my practice, these frame dimensions would suggest a maximum of about 400 mL although it is hard to tell without physical exam.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Unfortunately the best sizing can only be achieved with an in-person examination of your tissues and measurement of key breast parameters.  Certainly a thicker gummy bear implant in a full profile projection level will over a nice result.  Hope this helps.

Donald R. Revis Jr, MD · Answer

Good evening,
I would have to measure your chest, but based on your stats and goal photos I'm thinking 560-650cc XHP Mentor MemoryGel implants. I perform over 200 XL augmentations a year, more than any other surgeon in the U.S.

Robert M. Tornambe, MD · Answer

I appreciate your concerns and desires. 
I have a great deal of experience performing breast augmentation on bodybuilders, and I do not believe that you need to be subglandular as most of my body builder patients do not experience animation deformity after submuscular breast augmentation. Because of the increase size of the chest muscle, it may take longer for the muscle to relax and the implants to settle, but they all settled in quite nicely with a natural result.
It appears that because you have a fairly narrow breast diameter high profile silicone implants would be your best option and results similar to your wish photos should be attainable. Be certain to consult with a board-certified plastic surgeon. Best of luck.

Daniel Barrett, MD · Answer

Dear Kgo12345,
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

Connie Hiers, MD, FACS · Answer

I would suggest meeting with a board certified plastic surgeon, being examined and measured, and trying on the range of sizes that best fits your frame and tissue to see what you actually like.  Your surgeon will guide you the the best choices for you.