What results can I expect as a petite woman with 225cc breast implants?

Thank you for your question!

I can see that you prefer natural looking breasts. 

Before we talk about implants, I would like to discuss what
constitutes natural looking breasts, and what factors play a role in creating
them.

Natural breasts have the following characteristics:

The areola – dark pigmented region around the nipples –
should not be large relative to your nippleThe nipple should be above the breast fold – inframammary
foldThe 2 nipples should form an equilateral triangle with the
notch of your breast boneThe breasts should not be saggingThe nipples should sit directly behind the part of the
breast that projects the fullestThe breasts should appear symmetricalA recent study by Dr. Mallucci and Dr. Branford, titled
“Shapes, Proportions, and Variations in breast Aesthetic Ideals,” gives us 4
set of ideals in beautiful and natural-looking breasts. They are as follows:

An upward pointing nipple (angled at 20 degrees)A slope in the upper pole of the breastA tight curvature (convexity) in the lower pole of the
breast (i.e., below the nipple)An upper pole to lower pole ratio of 45:55 (i.e., the
percent of fill below the nipple should be 55% compared to 45% above the
nipple)If your breasts meet these ideals and those I mentioned
above, they will look natural. 

That being said, there are many factors that go into
creating natural-looking breasts, and a combination of the right choices
contributes to achieving the desired result. I mention some of these factors
below.

1) The size of the implant – a large implant that exceeds
your breast boundaries, or overly stretches your breasts, or is too round will
make your breasts look unnatural. In fact, with larger implants 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.

A board-certified surgeon will always determine a suitable
range for the implant volume after conducting some breast measurements and this
is called tissue-based planning. Measurements such as breast base width, the
amount of breast skin stretch, nipple to breast fold distance under maximal
stretch, skin quality, chest wall asymmetries, among others have to be looked
into. 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.

The combination of these measurements will also 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. I am assuming
your surgeon already took breast measurements and made the suggestion about the
implant size based on them. As such, that would be best for you to attain a
natural result.

2) The profile of the implant – How much the implant
protrudes or sticks out in the forward direction influences how much stretch is
put on the overlying breast skin, and excessively stretching the skin results
in negative consequences. Although the profile has to be tailored to the width
of your breasts, a high profile implant normally provides a more augmented look
rather than a natural look. As such, going for a more moderate profile or a
moderate plus would be better.

3) The shape of the implant – majority of surgeons prefer
round and smooth implants, but if your breasts do not have a natural shape to
begin with as we see in patients who have tuberous breasts, then you may
require the use of anatomic implants (tear-drop shaped implants) whose lower
half is more loaded in volume than the upper half corresponding with the
desired natural look.

4) Incision placement – incision location not only
determines the degree of trauma to breast’s soft tissues, exposure of the
implant to breast’s endogenous bacteria, pocket visibility and control, but
also the implant’s position vertically and horizontally relative to the chest
wall. For example, compared to the tranaxillary (armpit) or the areola (around
the nipple) incision, the inframammary (IMF) incision better allows your
surgeon to lower the inframammary fold to increase its distance from the
nipple. In many patients, the inframammary fold needs to be lowered in order to
allow the implant to rest at a level that appears natural relative to the
position of the nipple and areola, and in order to prevent the appearance of
excessive upper pole fullness. I need you to realize that an overly full
upper pole will make it obvious that you got implants to enhance your breasts.

5) Pocket – The decision to go behind the muscle or over the
muscle has to do with the amount of soft tissue coverage – “padding” under the
skin. Choosing a pocket that is tight with sufficient soft tissue coverage not
only prevents implant visibility, palpability, and risks of excessive
stretching on the breast, but also excessive implant movement into the outer or
inner sides of the breasts. A hand-in-glove fit for the implant allows for a
natural and long-lasting result. Your surgeon will do a pinch test in the upper
pole of the breast to see how much “padding” you have. If you have less than 2
cm, then you do not have much padding and it would be best to go under the
muscle. Generally speaking, if your ribs are visible under the muscle, then you
do not have much “padding.” If however, you have more than 2 cm of tissue, then
you have the option to go over the muscle or under the muscle.

I think you might find it helpful to know that 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. It was also found that normally breast augmentation
increases the cup size by 2. However, it is also important to consider the
profile as even a smaller implant with a high profile can increase cup-sizes by
the same amount.

All this being said, share all your motivations for surgery,
expectations and goals with complete honesty to avoid miscommunication and
post-operative concerns/regrets. Be as specific as you can about what you like
regarding your breasts and what you don’t like. If you trust your surgeon and
their judgment and the decision-making method used to choose the implant size,
then you should be in good hands.

Hope this helps

Thank you for the question.  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, and computer imaging) will be critical.  





Having said that, for most patients with your petite frame  and anatomic starting point, I recommend the use of round silicone breast implants placed in the sub muscular (dual plane) position. You will find many similar/representative examples on the attached link.











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 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, dedicated to breast augmentation surgery for petite patients) helps. Best wishes for an outcome that you will be very pleased with. 

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



#RealSelf100Surgeon



#RealSelfCORESurgeon