425cc of saline unders on 5'9" 160lb frame with 36B to begin with looking too big?

Question

My breast width is 14.5 and my surgeon said the smaller I go, the more risk of them falling to the side I have. I'm worried about them looking super obvious. She mentioned that the 425cc would look the "most proportionate" for the shape and size of my body, but on everyone else, 425 looks great but a little bigger than what I was hoping for.

Larry S. Nichter, MD, MS, FACS · Answer

It is very difficult to determine 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 350 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. . 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 below link

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

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon

Mark Schoemann, MD · Answer

Thank you for your questions. Before you make your decision
on procedure(s) size and shape of implants I would suggest that you meet with
a Board Certified Plastic Surgeon again and go over your concerns and what you
hope to accomplish.  Your surgeon should be able to explain to you why
they are recommending the size and procedure they are according to your current
breast tissue, measurements including your chest width and your desired
outcome
We have all our Breast Surgery patients not only utilize our 3D imaging so they
can get a real visual on what the implants will look like on them but also to
actually try on the different size implants with a tight bra and t-shirt to see
what they might expect. That way they have a good visual of what a 450cc
implant will do as opposed to a 350cc implant for example. You want to make
sure that you see a surgeon that will listen to you and your goals for the
procedure and discuss in detail their recommendation for size and shape not
only taking into consideration your desired outcome but also your breast
measurements before the procedure including your chest dimensions. And then let
you try the implants that they feel will give you the desired result so you are
in agreement with the size.
Most important is to pick a Board Certified Plastic Surgeon - Certified by the
American Board of Plastic Surgery. It can be hard and confusing for consumers
when a physician may tell you they are Board Certified. Make sure it is Board
Certified in Plastic Surgery as many Physicians are certified but it is in
another area such as Dermatology, Gynecology, ENT, or some other specialty that
does not have the years of training and Certification in Plastic Surgery
required to be a Board Certified Plastic Surgeon.
Rather than finding a non-certified surgeon that may give you better pricing it
can be helpful to find a newer Board Certified Plastic Surgeon that has years
of experience in training and surgery-required to become Board Certified in
Plastic Surgery but is newer in practice. They have the latest up to date
training and highest standards as currently set by the newest technology and
are able to pass on to the consumer much better pricing for Breast
Augmentation. The manufacturers of the breast implants encourage and assist the
newer Certified Plastic Surgeons by giving them special pricing on implants
which most will pass on to you, the consumer. Check for special pricing here on
RealSelf and make sure the surgeon is a Board Certified Plastic Surgeon and you
may find the perfect Plastic Surgeon for you who is able to work with your
budget without cutting corners!

Scott E. Kasden, MD, FACS · Answer

Hi mmnThe important thing in sizing of implants is the diameter, as you have indicated.  If you think that the implantw would look too big, try looking at a low profile implant.  also, take a sports bra in and a solid shirt and try sample implants on.  Remember they will look smaller in you (under the muscle) than on you.  Also, you will need to adjust to the new size.All the best.sek

Tom J. Pousti, MD · Answer

Thank you for the question. Online consultants will not be able to provide you with specific enough advice to be truly helpful.  Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.***Given your concerns, I would suggest that you spend additional time communicating your goals/concerns directly with your plastic surgeon, preferably prior to the date of surgery.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. For example, I have found that the use of know words such as “natural” or "C or D  cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
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/video, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Payam Jarrah-Nejad, MD, FACS - Account Suspended · Answer

Thank you for your great question.There are many ways to properly determine your implant size. Most important is in-office evaluation and many measurements we perform during a comprehensive evaluation.  This will allow us to determine not only the size (the "cc"s) but also review different types of implants.You will have many options be based on your medical history and physical exam which will include the tissue type, location of nipple and areola, breast folds, asymmetries to name a few. The actual implant size (the "cc") is totally individualized.  A few millimeters on chest measurements can change the type and size of your implants considering your goals.The Breast Augmentation results are mostly dependent on surgeons expertise, experience, dedication, and artistic vision. This is why the results may be very different from one surgeon to another. Make sure you have a thorough consultation with a board certified plastic surgeon who has extensive experience in this procedure. Check her/his experience, credentials, reviews, before and afters, and have a quality consultation.It is preferred for your surgeon to be member of "American Society of Plastic Surgeons" and also member of "American Society for Aesthetic Plastic Surgery". This means they have been evaluated by the society and recognized that the focus of their practice is high volume, honest, and high quality aesthetic plastic surgery.All the best,

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  One solution to properly fill your wide based breast would be to use smaller implants with a wider base such as classic or low profile.  Please discuss with your plastic surgeon.

425cc of saline unders on 5'9" 160lb frame with 36B to begin with looking too big?

Answers (7)

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