When debating between 2 implant sizes that are within allowable limits for my body, should I err on the side of the larger size?

Question

I've met with my surgeon and shared my goals. I am 5' 10", 135# and currently a 34A. I'd like to be a full C with a very natural looking result. We have chosen Sientra classic anatomical implants. My surgeon knows my goals and measurements. He recommended 350-400 cc's. Originally I was thinking I'd choose the 350 cc's because I don't want to be too big. However, with the amount of people that later regret their size, I was wondering if I should err on the side of the larger size?

Orna Fisher, MD · Answer

For your height and desired look with the classic anatomic implants, I recommend going with implants larger than 350 cc. However, I advise that you have sizing done in the office using sample implants in order to be more certain with the decision.

Donald Groves, MD · Answer

Hello and thank you for your question. Honestly, a formal in-person evaluation would be needed to determine the best treatment. There are several reasons for this: 
1) Bra sizes vary based on the clothing store (for example, Victoria's Secret tends to upsize everyone by a whole cup size)
2) Most women do not wear the proper exact fitting bra size for their bodies
3) The exact volume (in cc) needed to change cup size is different for different body types (e.g. 32A to 32D requires a different implant size than 38A to 38D)
4) Be careful NOT to fall into the trap most women do- they see a certain implant size (e.g. 285 cc) or perhaps their friend had a certain size, and they want or request this or another size based on that. Everyone's body is different- 285 cc implants on your friend might look VERY different than they would on you. Be very careful not to make this mistake, because the goal is to find the right size and shape for YOU- for your particular body and your breasts.

Because of those multiple factors, and because it is KEY to fully evaluate your breasts in person to make a full set of precise measurements to select the proper implant for you (incorporating factors like amount of breast tissue, implant type, base width, projection, etc), answering your question really would need a formal personalized consultation- to say anything before that would simply be guessing, which would be both unfair and unhelpful to you. Also, just FYI, each surgeon's measurements are slightly different, so numbers, experience, and overall aesthetic from one surgeon aren't necessarily the same as those from another surgeon!

Your breasts are such a KEY area of your body and your femininity- therefore, you should ONLY trust an experienced aesthetic plastic surgeon. As such an expert, I have had extensive training and experience with complex aesthetic surgeries under a multiple world-renowned experts in the field. I’d recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with aesthetic plastic surgery procedures) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Clark Schierle, MD, PhD, FACS · Answer

The exact choice of size that will work best for you is an important decision that you should make with your board certified plastic surgeon. 3D Vectra imaging and simulation, the Mentor gel sizing system, rice filled implants at home in your bra, and bio-dimensional analysis are all methods that can be employed to help you come to a decision. Because size is such an important component of decision making in breast augmentation our office employs all of these techniques with each patient to ensure the highest rate of satisfaction possible. Good luck with your decision!

Kenneth Hughes, MD · Answer

There is blunting of the size when placed inside, and it may be advisable to select a slightly larger implant.  I would search for the board certified plastic surgeon who you
feel is most likely to give you
the best results. Look at reviews and before and after pictures on that
surgeon's website. Kenneth Hughes, MDLos Angeles, CA

Gary Lawton, MD, FACS · Answer

If you try on sizers you will have a better idea of what they are going to look like after surgery.  The sizers typically look somewhat larger than the implants at that volume, so it is usually safe to go a little larger, like you had suggested.

Richard H. Tholen, MD, FACS · Answer

You are making a very common self-assessment. Every woman wants the "Goldilocks" implants--not too large, not too small, but JUST RIGHT. You are also wise to note that many women later wish they had chosen larger, precisely because they "don't want to be too big." Without knowing you, your lifestyle, and your personality, your anatomy would certainly argue for the large(r) implants. If we were discussing 700cc vs. 800cc, there might need to be more discussion, but I still have detailed discussions with each of my patients prior to surgery, even when the choice is 350 vs. 400cc. Not because I have to know what they want so I can order the "right" size (in our office we stock a full inventory of saline and silicone implants is all sizes and profiles so we don't have that concern), but because I can use slightly smaller or slightly larger based on all the information I have gleaned form my patient right up to the time of surgery, including what I assess about her tissues as I create her pockets in the operating room.Some women are intrinsically conservative, are the most fearful of "being too large," and would truly be the most likely candidate for the smaller of your two choices. Paradoxically, these women often seem to be the ones who later most regret not going with the larger choice! Not always, but so frequently that I ask many questions to discern their real attitudes before I go into the operating room.Others are more "go for the gusto" and the choice is easier for them--just go with the larger implants.Remember, we are NOT choosing between "Oh my God" or "Why bother," you are asking about 3 tablespoons and 1 teaspoon difference. BTW, this amount is scarcely visible, and why implants come in those gradations--they are intentionally made that way to be at or below the threshold of visible difference!You will look great with either size choice. I would question your use of textured shaped implants, however. These cost more, require a larger incision, are rotationally sensitive (must be placed in "perfect" position to avoid asymmetry since they adhere to the tissues and won't move or rotate), do not drop, settle, or flatten out when reclining or standing (they stay teardrop-shaped in all positions--in my mind, this is decidedly NON-anatomic, since natural breasts flatten and drop slightly to the side of the chest when reclining), and they feel more firm compared to smooth round implants. Remember, smooth round implants are less costly (still cohesive; do not "leak;" and do NOT require periodic MRI scans IMHO), require a smaller incision, are NOT rotationally sensitive (round, so there is no up or down position), and they drop and settle as things heal, giving a nice teardrop shape when standing and a flatter, round shape when reclining, just like "real" breasts, AND they feel more soft. And, did I say they will save you some money? You just need to be sure your surgeon is comfortable with smooth round implants vs textured teardrop-shaped, since the pockets and positioning must take into account their differences. If your surgeon "only uses one kind of implant" you may wish to get additional opinions.Ultimately, choice of surgeon is much more important than choice of implants. Either choice will give you great results, but I would recommend smooth, round, cohesive silicone implants, and probably the 400s. For more information, you may wish to read my Comprehensive Guide to Breast Augmentation by clicking on the web reference link below. There is a whole section on choosing implants, including type, size, and all of the various options. Best wishes! Dr. Tholen

Alexander G. Nein, MD, MS, FACS · Answer

The best way to get an idea of about how large you would be
is to try a test implant in a sports bra. It’ll give you a feel for how large you’ll
be although the final result will “appear” slightly smaller. All our patients
choose their own implant size with guidance from us as to an appropriate starting
size based on their measurements. Nearly all patients choose a somewhat larger
size. At six months nearly all women wish they had chosen a larger size than
they actually did choose. Nevertheless, be aware that the larger the implant,
the greater the risk for long term problems. It’s not guaranteed but it is a
greater risk.A size increase of 25cc is negligible and wouldn’t really change
your risk, so if that is what your debate is, then go up. A size change of 50cc
or more will be apparent. In the end, any decision has trade-offs – both good
and bad. Evaluate the various considerations and decide what’s important to
you. You are after all doing this to be happy with yourself. Best wishes to
you!

Todd C. Case, MD · Answer

In general, most patients wish they went bigger after things settle down following surgery.  If you are looking at two choices that are close in size, pick the larger one, so you don't later say "I wish I went bigger".  when talking about volume, loose rule of thumb is 30 ml is an ounce or about the volume of a shot glass.  It is enough to make a visual difference that you are a little bigger or smaller.

Robin T.W. Yuan, MD · Answer

I always ask my patients what will make them more unhappy, being bigger than they expect or being smaller? While statistics in the past have shown that women more often regret not going larger, woman who are too large are generally more unhappy than those who come out too small so automaticaly upsizzing a woman may make for some quite unhappy patients. My goal for cosmetic surgery, which is elective and not medically necessary, is to make patients more happy, but more importantly, it is often to not do things that make them more unhappy.Robin T.W. Yuan, M.D.

Tom J. Pousti, MD · Answer

Thank you for the question. As you can imagine, every patient's goals and preferences are different; some patients in your situation would rather "err” on the larger side, some would rather “err” on the smaller side. In my practice, I think that about 80% of our patients would rather err on the larger, rather than the smaller side. Unfortunately, online consultants will not be able to provide you with specific enough advice (in regards to the best breast implant size/profile) to be truly helpful.
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. I have found that the use of words such as  “natural” or "full 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 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.

When debating between 2 implant sizes that are within allowable limits for my body, should I err on the side of the larger size?

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