Help w/size of implants! 34D natural deflated post nursing. Suggested 300cc mod on my right and 375cc mod+ on my left side?

Question

I am having a subglandular BA (since I have enough breast tissue and pass the pinch test) to fill upper pole and correct asymmetry of 100cc between breasts. I’m a natural 34D and don’t want to be much bigger only fuller/perkier at the top.2 surgeons I consulted w/ confirmed there was no need for a lift. My surgeon is saying 300cc mod on my right and 375cc mod+ on my left side. Is this too big? Do I really need this size for diameter of my breasts? Will they sag after? What CCs do I need

Ram Kalus, MD, FACS · Answer

The fact that you have consulted the RealSelf group suggests that you are looking for some reassurance beyond your own plastic surgeon's recommendations. Needless to say, your plastic surgeon has the advantage of having evaluated you in person. Unfortunately the information you provided in your question is insufficient to properly advise you, and the "100 cc difference" is at best, your plastic surgeon's guess. It might also be a 50 cc difference or a 150 cc difference. The 300 Moderate Plus and 375 Moderate Plus may be just right, or not, and your plastic surgeon's judgement, experience, and inventory all matter. Expressing your desired cup size is notoriously inaccurate, and final breast size is the most common reason for patient disappointment after breast augmentation, either too big or not big enough. In your case, your asymmetry is what you presumably want to correct to the greatest extent possible.

As we think about breast implant size, Volume (300 versus 400), is far less significant than implant width and projection. Implant width is similar to shoe size. The implant literally needs to fit into your breast and chest.  The volume and projection are what will determine the “look” you want, similar to the style or type of shoe you would select. It is true that for a given volume a high profile implant will have a narrower diameter, and it is also true that a person such as you with a petite frame will require a narrower diameter implant than a patient with a broader chest or larger frame.  Other considerations such as saline versus silicone are also important, as are "round" versus "anatomical" or "form stable" or "shaped", smooth surface versus textured, and softer versus firmer with the different levels of gel cohesivity.

In my practice, besides a thorough interview process and physical examination with careful measurements, we use on lay sizers within an unpadded bra to help you understand what you are likely to look like in a bra, bathing suit, or T-shirt with a given size implant. In addition, and this is critical, we ask all of our patients to provide us with photos of their desired final look, with images of women’s breasts that most closely resemble the look they are trying to achieve. This serves as a visual guide that thankfully rarely leads us astray. This algorithm which we have been employing for over thirty years has proven to be very successful.

Make sure that you share with your plastic surgeon photographs of your "favorites" or ideal. 
Best of luck to you.

Nelson Castillo, MD · Answer

Thank you for your question and photographs. I think you are starting from an excellent position and should anticipate a nice result. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing additional board certified plastic surgeons to ensure that the implants you decide upon are the right ones to meet your expectations. Several offices should allow you to "try on" several of the implants so that you can have a better visual representation as to what they would look like. Best wishes!

Gary M. Horndeski, MD · Answer

At size 34 D, you do not need implants but do need a lift. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants or fat transfers can be placed.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear bedeliasara,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, 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 it is 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, every one of them has 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.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

The main problem is that even if size is compensated for, you will have asymmetry because one nipple is much lower. The only way to get the nipples the same height is with a lift. You can opt for no lift but the implants may actually accentuate your asymmetry. Consider the lollipop lift and do it on both sides.

Harry T. Haramis, MD, FACS · Answer

Subglandular implants can help sagging without a lift, breasts will still look low, more natural. The recovery is easier and is a slightly higher risk of capsule as compared with submuscular.

Generally, larger implants “lift” better. 300-375cc seems appropriate.

All breasts are different right to left before and after any surgery. Different implant sizes can help make them more even. Temporary sizers can be used during surgery to confirm implant cc’s for right and left.

Further discussion with your/a plastic surgeon is recommended until you feel comfortable.

Kenneth Hughes, MD · Answer

Hello, thank you for your question. A board certified plastic surgeon will be able to guide you to the correct size implant. Based upon measurements of your chest wall and breast imprint width as well as knowledge of all breast implant sizes and profiles should make this process easy. Try on a profile bra with various silicone cc sizers your PS recommends under a tailored blouse, tank top, bikini, workout clothes, and other garments you typically wear so that you have the best idea of whether the garments fit as desired with the implant selected. Select the size that boosts your self-esteem, and fits your anatomy. Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision.

Connie Hiers, MD, FACS · Answer

You might want to consider how much bigger you wish to be. With 375 cc's you will gain two cups in size. You might find that is too heavy on your neck and shoulders. I would suggest asking to try on a variety of sizes to see what you like.

Douglas Taranow, DO, FACOS · Answer

It is very difficult to choose implant size using photos without a physical exam.
You have significant asymmetries with breast hang and nipple height.  This should be addressed with a unilateral breast lift.  The size of the implants can be determined during surgery using sizers prior to choosing the correct implant.
Dr. T

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photos but size is an individual decision based on measurements and putting implants in a bra till you see the volume on your chest that you like then your surgeon can pick the best shaped implant for you at that volume. So go resize and feel more assured about your implant choice

Dr Corbin

Dr Corbin

Help w/size of implants! 34D natural deflated post nursing. Suggested 300cc mod on my right and 375cc mod+ on my left side?

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