Are 435 CC's High Profile Gummy Bear Implants too big for me? (photo)

Hi Ells,TA 435 cc implant is definitely getting up there in size for your build.  But this is perhaps the hardest decision for a patient to make, as well as
the surgeon. Cup size estimates can be misleading, but I generally advise
patients that they will experience an increase of approximately one cup size
per 200 cc. You can try on implants in the office by placing them into a
special bra.Approximately 50 cc (1-2
oz.) is added to the final volume to account for flattening of the implant in
the partial submuscular pocket. Once you decide on a size you like, then add on
about 25-50 cc, because in real life the implant will be flattened slightly by
your tissues.Multiple measurements need
to be taken to fit an implant to your exact anatomy. Have your surgeon's
office show you the charts of the implant dimensions for the various profiles
of silicone and saline from the manufacturer. Then you and your surgeon
can piece together the puzzle by matching your measurements, with your wishes,
versus your tissue cover and the available implants to arrive at
a surgical plan.Keep in mind
larger implants tend to have more problems over the years.Since silicone implants wrinkle less than
saline implants, they might be your best bet.You can also approximate this at home by measuring out one ounce per 30 cc or in your case about 14 ounces, and an equivalent
amount of rice placed into a cutoff foot of old panty-hose, and put this in
your bra. Wear this around the house for
a while, and see what you think.Implant
size must square with assessments of tissue cover, breast diameter, and chest
wall width. Multiple measurements of your chest wall are taken (seven in
total). Implant size selection has been
an issue of much discussion. Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape. A photo album of patient pictures is maintained to assist them. These
photos ultimately help in determining where the implants will be placed, since
they can be shifted inside (to provide more cleavage), to the outside, up or
superiorly, and down or inferiorly during surgery. In determining the final
size selection, I always place the highest priority on the preoperative
measurements and potential tissue cover. Then, the patient’s verbal requests
are factored into the analysis.I already know you are seeing a board certified plastic surgeon
because Sientra only sells to BC plastic surgeons (by ABPS - The American Board
of Plastic Surgery) who are members of ASAPS (The American Society
for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of
Plastic Surgeons). So that is great!
Also Sientra is the only implant
company who has a warrantee if you develop a capsule after receiving their
textured implants. They have a special process which makes the
texture. This implant shell is unavailable elsewhere.All the
best, “Dr. Joe”

It’s always difficult making decisions about breast
size without performing a physical exam or seeing pre-operative pictures.In addition, it’s important to understand the
patients’ aesthetic goals.Each patient
has specific anatomic findings and unique aesthetic goals regarding size and
breast shape.All of these factors
should be considered when choosing the size of breast implants.Even
when tremendous care is taken pre-operatively to determine breast size, the
final decision needs to be made in the operating room by the surgeon.At this point, an assessment can be made
regarding how the patients’ breast tissue interacts with the breast implant.In some cases, when larger implants are
utilized, patients can lose a natural look and appear artificial.Occasionally, obtaining a specific size isn’t
always a good idea.Results are often
better when a surgeon has the ability to make adjustments in the operating
room.In
your case, it’s important to thoroughly discuss your aesthetic goals with your
surgeon.Make sure he has the latitude
to do what’s best for you in the operating room so he can meet your aesthetic
goals.It’s important that you have an
approximate idea of the breast implant size that you’re considering but don’t
become married to an absolute number.It’s important to remember that going with an implant that’s too large
can result in an artificial appearance.In this particular case 435cc implants might be too large for your
petite frame.

Thank you for the question.   Despite your good description of goals, 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 and direct examination/communication in front of a full-length mirror)  will be critical.
Generally speaking, the best online advice I can give to ladies who are considering  revisionary 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 "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.
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.
I hope this (and the attached link, dedicated to breast surgery concerns) helps.