34A wish to be 34D, is 500cc of silicone enough?

Choosing what size implant to use will depend on many factors and is best decided during a physical exam and discussion. Photos can help the initial discussion. The appropriate size implants will depend on the width of the breast, the distance from the nipple to the infra-mammary crease, the thickness and elasticity of the skin and subcutaneous tissues. In basic terms the appropriate size implant will depend on what fits. The discussion will depend on one's requests and expectations based on how big versus how natural. The larger the implant is beyond what fits appropriately, the less natural will be the result. The larger the implant extends beyond what fits, the more you will feel the implants and potentially see the outline of the implant or even rippling on the sides. Much depends again on measurements and thickness of the skin and subcutaneous issues. Someone who is thin, with small breasts to start, will have a more narrow range of what will fit if they want a natural looking result. Someone who has larger breasts and thicker subcutaneous tissues, meaning more to cover an implant, will have a greater range of sizes to choose. High profile implants can also be used, at times, to give more projection and a larger appearance. Choosing appropriate size implants makes all the difference. Review lots of photos and ensure that your surgeon produces results consistently that are pleasing to you. Understand your measurements and choice of implant size. My personal choice is always for well done, rather than over done !  Choose a Board Certified plastic surgeon that will take the time to review all this with you and help you get those great results ! Best of luck. Dr Sam Gershenbaum
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It is very difficult without assessing you in person to know if the implant size you mentioned will be a good size for you. Keep in mind that implant size selection not only depends on your personal preference, but it also depends on your unique measurements. There are various types of implants that can help you attain the look you are going for. A thorough consultation with a board certified plastic surgeon will allow you to communicate what your desired result is and will inform you as to what is possible to achieve your goals. We have a device called the Vectra 3D imaging system that shows you what you will look like with any implant. Our patients are very happy with the choice of implant they make when using this system. To learn more about breast augmentation, you can read “A Comprehensive Guide to Breast Augmentation."

I appreciate your question!

After performing hundreds of breast augmentations, I have found that 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. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you 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 softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is 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. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

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 

#RealSelf100Surgeon

#RealSelfCORESurgeon

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. 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 breast surgery. Hope this helps and good luck with your surgery.

Hello and thank you for your question.   Congratulations on your upcoming procedure.   The
best advice you can receive is from an in-person consultation.  The size, profile, and shape of
the implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Dear Deeglamxo,determining the ideal breast size and matching that goal for the patient is the most difficult part of breast augmentation. It starts and ends with the patient. 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 its 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, everyone of them have 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.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Patients often think in terms of cup size when considering
augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of
volume. This can lead to some confusion when sizing. Additionally, it is
important to remember that cup size itself is not standardized with variations
from one manufacturer to another. Unfortunately, as many women can attest their
cup size in an industry leader such as VS is not necessarily transferable to
another brand.
Another point which is often under appreciated is that of
anatomy and starting point. Any implant will add volume to the volume which is
already present. The implant is additive. A particular volume will not
necessarily confer the same cup size to different patients (often times it will
not even confer the same cup size to different breasts in the same
individual...remember they are "sisters" not
"twins"). 
A general rule of thumb is that 125cc can represent somewhere
between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc)
are typically less consequential representing a volume change of less than
a shot glass. However, I have found these numbers, at least anecdotally, to be
of little help. Patients often present with notions/goals which do not
correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools
including:
-3D imaging (has the added benefit of offering a volumetric
analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look
rather than a cup size. Once a patient settles on a look that pleases them the
overall cup size increase becomes less relevant.Without measurements or photos, it is difficult to offer any real advice. As I stated above, stay within the parameters defined by your unique chest dimensions and try not to focus on cup size as this is variable. Settle on a look that you love...if you achieve that look it is doubtful that you will be disappointed if the bra label does not meet your expectations.
As always, discuss your concerns with a board certified plastic
surgeon (ABPS).

I think the most important thing to do would be to try on sizers with your surgeon.  Because 500 cc is going to look differently on different peoples frames.It is important to realize that the ultimate breast size and shape depend upon so very many variables.  A 300 cc implant on a petite woman with a thin frame may look quite large, but that same implant in an overweight woman may be barely noticeable.  Size and shape of the result depend upon the volume of the implant, the shape of the implant, if it is over or under the muscle, your skin and its resilience, stretch marks, the degree of breast sagging, chest circumference, amount and distribution of the natural breast tissue, etc.  For this reason, it is impossible to give reliable advice based simply upon height and weight, or even photos. The only way to approach reliable predictions is with an in-person examination with a board certified plastic surgeon, the use of sizers, 3-D imaging, and most importantly, relying upon the skill, expertise, and experience of your chosen  Board-Certified Plastic surgeon.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

The most important consideration when choosing implant size is if there is adequate breast tissue to cover the implant. Beyond that the specific choice is a very personal decision and many factors can play into the choice. For more information regarding breast augmentation and implant choices in particular please go to our website drnein.comAs a general statement a 500cc implant is relatively large and also relatively heavy (over a pound apiece). There a re some special considerations regarding long term results and long term sagging with heavier implants. I would discuss these in detail with your plastic surgeon.

NO POSED PHOTOS! Very hard to recommend a potential size. Best to seek in person opinions to try on implant sizers. The issue is could yu place a 500 cc implant in to small of a breast?