Why won't my PS put a larger implant in? Is 350cc too small?

Question

My PS says that a 325cc or a 350cc implant will be the right size. I am 5'3 117 pounds and my bwd is 11.7. He said I would not be able to fit a large implant in my chest due to my diameter and small chest wall and that the 350cc is proportionate to my body but they will look smaller under the muscle . The 350ccs already match my bwd. I'm looking to be a small d. I know that with specific pts this implant is big enough and with others a 400cc is required. Do I listen to my PS and get a 350cc?

Martin Jugenburg, MD · Answer

Thank you for your questio

Please know that it is a common misconception that implant size correlates with the bra cup size. Many patients are often confused regarding that because of reading reviews or hearing about what their friends got.

First, bra sizes clearly vary among manufacturers, and they can label the cup size by any designation they choose. So when you say you want a small d-cup, it is not much helpful to us surgeons. But if you have specific measurements, and a specific bra, then the discussion can move forward.

Second, there is a confusion over sister sizers which complicates things. For example, a patient wearing a 34C may also fit into a 36B bra.

With so many problems, it is no surprise that many patients are dissatisfied with their outcomes. Thus, establishment of an accurate band-size is important, as is recognition that cup sizes are a range and ever changing.

Even though you may give importance to cup size designation, what should matter most is that the implant looks good aesthetically and that the chosen bra fits and feels comfortable.

This is exactly why patients must have a consultation.

I am assuming you have gone to a board-certified plastic surgeon, and I believe they have assisted you in choosing an implant that is more tailored to your breast characteristics. They must have done this because if you want natural looking breasts, the implant has to fit YOUR body dimensions. The more you deviate from the proper fit, the more fake your breasts will look.

For this reason, please follow your surgeon’s recommendation regarding implant selection as long as you trust them.

Surgeons use what is called tissue-based planning. The planning takes into account the effects of implants on tissues over time, risks of excessive stretch, excessive thinning, visible or palpable implant edges, visible traction rippling, ptosis (Sagging), and breast tissue wasting. To determine the implant size, breast measurements must be made: 1) Base Width of the existing breast tissue, 2) skin stretch, and 3) Nipple-to-Inframammary Fold distance. The combination of these measurements will help determine tissue coverage and the required implant volume to optimally fill the breasts. For example, if your breast base is very wide, we will require a higher implant volume to avoid the “rock in a sock” appearance.

If you choose a large implant that exceeds your breast boundaries, or which overly stretches your breasts, or is too round, then it will make your breasts look unnatural. In fact, there is higher likelihood of bottoming out (i.e., an empty upper pole, nipple sitting too high on the breast), double bubble deformity, implant malposition, implant visibility, breast sagging, and breast tissue wasting. So going big is good, but going beyond limits will get you in big trouble…pun intended.

Now, if we consider a single bra manufacturer of a single style, then we can say that if you are currently at a B-cup (please note that this is my assumption), the chosen size of 350 cc may get you to a “small” D-cup. I say this because a study by Dr. Bengtson and Dr. Glicksman titled “Standardization of Bra Cup Measurements” has shown that the average implant volume required to increase the cup-size by 1 size is equal to 205 ccs. For 2 full cup sizes, it would be 410 ccs.

It is important that you communicate your goals very clearly, but understand that you need to have realistic expectations. If you did not get an opportunity to discuss the fact that you are hoping for a small D-cup, please share that now with your surgeon.

A second opinion would be best obtained through an in-person consultation, but I would like to let you know that there is no patient that does not appreciate their surgeon’s advice in the long-term seeing all the negative consequences that can happen in the short term with larger than normal implants.

Hope this helps, and best of luck!

Jerome Edelstein, MD · Answer

Hello,Thank you for your question. Your Plastic Surgeon will be recommending implants which fit your base width and will achieve the look you desire. The exact size and CC's which are ideal for everyone are different- quite individual. It will be difficult to predict bra cup size as well because there are no standards for bra sizing. My patients find it helpful to try on the implant sizers with a form-fitting T-Shirt in the office in order to get an idea of what the breasts will look like.Choosing your size can be stressful and confusing but I recommend that you discuss with your Plastic Surgeon and trust their expertise to guide you. A second opinion would be best obtained in person.All the best

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question. In general, implant size does not correlate with bra cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory (e.g, implant type, incision, placement, lift, etc). I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc.  A preoperative sizing kit is helpful in my practice. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width.  I would discuss your desires and concerns again with your surgeon. I would not proceed until you are comfortable with your decision and with the plan of your surgeon. Hope that this helps! Best wishes for a wonderful result!

Carlos Mata, MD, MBA, FACS · Answer

Hi Jklila, Thanks for
your question. Some pictures would definitely help
assess your breast concerns. The decision is ultimately yours. 50cc is not that much of difference but the one thing you do not want to do is get a pair of implants and then decide that you want to go bigger. I would recommend getting a couple of other opinions and unless your are 100% committed to your surgeon. If you are then trust their decision making ability. We offer complimentary 3D imaging so that patients can see what they may look like. Its not a guarantee but it is pretty accurate and better than just trying sizers on in the office. You get to see the real you and not someone else's breast on their body. Remember that there are also ultra high profile implants that may fit into your chest. Discuss with your surgeon. Good Luck!

All the best,
Carlos Mata MD, MBA, FACS,

@breastaugmentation @SiliconeImplants @docmata
#drcarlosmata

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

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon

David C. Yao, MD, FACS · Answer

Thank you for asking. Breast implant selection is an important decision. The collective picture of a patient's goals and body anatomy need to fit. Too large or too small an implant will either over stretch to bottom out or underachieve the patient's goals. It's important to realize that proper suzing can only be done after being seen in person and only you PS has done that here. Ask for an understanding of why 350 cc is being chosen for you. Always see a board certified plastic surgeon. Hope that helps- best wishes!

Christopher J. Davidson, MD, FACS · Answer

Good question.  The decision about breast implant sizes is one that many women spend many hours considering.  Unfortunately, the diameter of the implant and the size of the chest wall do dictate, to some degree the size of the implant.  That being said, there are many implant choices available with various projection possibilities.  I recommend that you consult with a board certified plastic surgeon to explore how best to meet your expectations.  Best regards.

Samuel Beran, MD · Answer

As each patient is an individual the appropriate size implant is different for each patient.  In my experience, there is not one predetermined implant for each patient.  Rather there is a range of implants that fit properly in each patient's chest.  I ask patients not to focus on specific cc's, but instead to tell me about their desired cup size or look.  Some want "natural" and some "artificial".  For others its all about a specific cup size.  In the end, if you have chosen an experienced board certified plastic surgeon you should let them guide you in picking the right implant for you.

Farah Naz Khan, MD · Answer

Hard to answer this question without specific breast measurements AND an in person exam. Remember to choose a board certified plastic surgeon who actually takes the time to measure you and examine your breast pocket The goal of breast augmentation is to optimally fill your breast pocket, not to overstuff or understuff it. At my practice, we utilize a series of 5 breast measurements that help me determine the implant size, which in turn helps me deliver a 24 hour recovery, regardless of the implant size. Do your research and choose a surgeon who takes the time to sit down with you and discuss your goals/expectations to determine the best size for you. If you trust him, you should go with his recommendation. Good luck!

Hector Milla, MD · Answer

Hi and thanks for your question. Some photos would have helped. It is very important for us to follow the patients anatomy measures, if this is not respected malposition may occur. If you have doubts go and see another board plastic surgeon.Best wishes.

Why won't my PS put a larger implant in? Is 350cc too small?

Answers (16)