Choosing the right size breast implants with 3D Simulation and Rice Sizers
Thank you for your question. There are actually multiple factors that determine what implant size is right for you. It is important that you communicate your true goals for breast size and shape with your surgeon. I have found a combination of personal consultation, 3D imaging, and using sizers to be the most effective way to determine what implant size would be a good choice for you. When looking at your options, an important consideration is your breast width, which should be measured by your surgeon during your initial consultation. By measuring the width of a patient’s breast I am able to determine what size implants will help reach your goals. Often times patients will come in with an idea of what size they are interested in because of a photograph they’ve seen on the internet, but do not realize that 300ccs can look drastically different from one patient to the next based on their unique body and breast width.
Another very important tool that helps to envision what each implant size will look like on your body is 3D simulation. The 3D simulation, also known as Vectra imaging, uses pictures of your own body, which allows you to see what each implant size or style will look like on you specifically. Using this technology, we can try several different sizes of implants, and you can choose your preferred size.
Rice sizers can also be very useful, as shown in the attached video. To make rice sizers, simply cut off the foot of an old pair of panty hose and fill it with the correct amount of rice to mimic 450ccs. 1 cup of uncooked rice is equal to 250ccs, so to make a sizer with 450ccs, use about 1.8 cups of rice. Once you have the rice sizer made, you can put it inside an unpadded bra to get an idea of what it will look like. The benefit of using rice sizers is that you are able to try them on for an extended period of time, and even see what the size looks like in different items of clothing.
It is rare that we use bra size to determine what the patient’s goals are since bra size is often extremely subjective. It seems that every store has a different measurement system, and what might be considered a “D” to some people, will not be to somebody else. For that reason, I find that bra size is not as useful of an indicator as sizers and the 3D imaging. If, after using rice sizers and 3D imaging, you feel as though 450ccs is larger than you want to go, it is always good to talk to your plastic surgeon about what your other size options are.
Hope this helps.
Nick Slenkovich, MD, FACS
What size do YOU want to be??
Missing in your text is an indication of what bra size you'd like to achieve after your augmentation. If you are looking for a significant increase in volume (to a D or DD, I would think) then 450cc may be reasonable. If you want to be smaller, though, then a 450 would be too big.
A variety of techniques can be used to illustrate what a particular implant volume will do to your size and proportion. We utilize Vectra 3D imaging in our practice, and I have found that to be very helpful and accurate. We also have patients try implants and sizers on to help patients decide. Ultimately, the volume you choose has to make sense with your body frame and ultimate goals. If you are unsure, you should discuss this with your surgeon.
Best of luck!
Breast Implants / Breast Augmentation/ Cohesive Gel Implants / Silicone Implants / Revision Breast Surgery
I appreciate your question.
The size of implant 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!
Certified Plastic Surgeon
Hills Breast and Body Institute
The right size for you
It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.
Is 450 too big?
How to Pick the Right Size and Shape of Breast
One of the more frequent questions I'm asked as an aesthetic plastic
surgeon for patients considering breast implants is "how do I know what
size, and shape I need?” The answer
to this question has changed dramatically throughout the 25 years that I've
been doing breast augmentation. I've also learned that the words that patients
used to describe either what they want or don't want can be completely
misleading into what I interpret their meaning to be. Therefore, I like to
request that our patients considering breast augmentation bring in photos of
both what they think they like and what they don't like. There seems to be a
multitude of sources on the Internet where these photos can be downloaded. By
looking at the patient's desires, I get a better understanding of what they
want. We no longer recommend that we place the exact implant on top of the existing
breasts and then place a stretchy bra over it to give us any idea what that
exact same implant under the muscle would produce in size. That method, in my
opinion, will always over represent what the actual result will be. If you are
going to use a sizing type method, then Mentor makes a shell sizing system such
that, when the shell size corresponding to the implant that it represents is
placed over the existing breast and in a bra, it will better represent what
that size implant under the breast and muscle will look like. We've also used
3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this
method, a three-dimensional photograph of the actual patient is taken and can
be seen on a large screen television by both the physician and perspective
breast augmentation patient at the same time. We then can place all of the
different implants that are available under that image and decide what size,
shape, fill ratio, and height to base width relationships will look best for
each patient. Silicone gel breast implants come basically into shapes either
round or shaped. They also come with either a textured or smooth surface. In my
mind, there are advantages and disadvantages of every scenario and combination
of those choices. Most of the time a round smooth implant placed under the
muscle works very well for breast augmentation patients. It's then very simple
to just look at size and ratio projection to base width and select the perfect
implant for that patients shape and desire. Sometimes we would like to use a
textured surface implant. Here the advantages are that the textured surface
implants tend to migrate less in the pocket, as there is some frictional
resistance to motion. Another advantage of textured implants is that the
capsular contracture rate, especially when implants put above the muscle, is
less than for smooth wall implants. Shaped implants, because we do not want
them to turn in the pocket, are always textured. My planning method to optimize
the best implant for each patient is begun with a measurement of the base width
of the breast. We would then like to subtract about a centimeter and a half
total off of that number so as to have coverage of breast tissue over the
implant. We then will have a range of implants whose base width matches that
number. If we go larger than that number, which sometimes patients will want,
we as plastic surgeons know that these larger implants can have more problems
down the line. For instance, larger implants may migrate below the crease which
one has to lower at the time of surgery in order to get the implant in. When
these implants migrate below the natural crease, they can create a second
crease in what we call a "double bubble". Large implants can also;
because of the pressure they put on the overlying breast tissue, thin that
tissue out such that there is less overlying breast tissue over the implant as
time passes. After we have the base width, our next decision needs to be what
is the ratio of the base width to the projection of the implant. Essentially,
there are usually four choices ranging from fairly flat which is called
low-profile, to progressively more height and less width with the same volume
of silicone gel, which is called ultrahigh profile. There are two profiles in
between which are the ones more commonly used and these are called moderate
profile and moderate profile plus. Common scenarios in which taller implants
would be desired may be in patients who want a larger look than their natural
base with would allow or have a fair amount of loose overlying skin that were
trying to hold up. For patients who want a more natural look, a moderate
profile or moderate profile plus shape is more desirable. There are also
anatomically shaped implants. Rather than being around these implants can
either be taller than they are wide or wider than they are tall. There are good
reasons in patients to use either. For instance, in the patient's with very
widely spaced breasts and a large breastbone, a shaped implant that's wider
than it is tall can help hide that a little bit. Another example of the patient
in who a shaped implant would be best, is that patient with laxity after
childbirth or weight loss. When the nipple is just at the level of the
inframammary crease, we can sometimes get away with a tall implant that is
anatomically shaped such that the nipple when is it at the lower two thirds of
the breast mound created by the implant still looks good and natural and may
obviate the need for a breast lift. By spending some time, long before the
operation takes place, using the Vectra® 3-D imaging method, we can decide what
type, shape, and ratio of width to height would best serve the patient's needs.
We can then avoid what is sometimes done which is the placement of sizers at
the time of surgery. These sizers, in my opinion, have a few negative
implications. One is that there is a cost inherent in using them and usually
multiple ones are needed to make a decision as to which implant would look
best. I also believe that placing sizers in and out of the breast pocket can be
traumatic to that pocket and can cause bleeding. For me, the state-of-the-art
in today's breast augmentation is to decide long before the operation exactly
which implant would look best using computer animation. A new wrinkle into the
choice of breast implants is that breast implants now come with silicone gel
that is filled to a higher volume in the shell where it is placed. This will
allow for a round smooth implant, for instance to collapse less in the upright
position mimicking more of the look of the shaped implant. When patients show
me a photo of a very rounded upper part her breast, I would likely choose one
of these higher volumes implants such as the Natrelle Inspira® silicone gel
breast implant. Often times patients will present with breasts that are of
different sizes. One of the options to correct this is to use breast implants
of different sizes in order to best create symmetry. One of the newer methods
to help in symmetry creation is to do what we call a hybrid breast
augmentation. In the hybrid breast augmentation, the patient who has asymmetry
of the breast to begin can have matching silicone gel implants placed and the
overlying breast tissue can be made to look the same in volume and shape by
using fat grafting. In that way, no matter what the change in weight of the
patient is over time, the breast is more likely to have the same or similar
size. When it comes to symmetry, I like to tell our patients that they should
consider their breasts to be sisters that live across the railroad tracks from
each other rather than twins. With proper preoperative planning and flawless
execution of breast augmentation, this can be one of the most satisfying
aesthetic plastic surgery outcomes for both patients and physicians.
450cc too big ?
The best cosmetic result in any
particular breast augmentation patient depends on a variety of factors,
including: Your individual anatomy, desired outcome, realistic expectations, a
thorough discussion with the plastic surgeon about the options, and an
understanding of the pros and cons of any particular implant choice. Proper
sizing is not just about the number of cc’s. The thickness of your tissue,
breastdimensions which include the width, height, and projection, as
well as chest wall width all need to be considered when choosing an implant.
Trying on implant “sizers” of various shapes and volumes while wearing a tight
t-shirt, bra, or bathing sit at a preoperative visit will help you and your
surgeon choose the optimal implant.
There are no manufacturers' standards for cup sizing in the bra
industry. The cups of a 32 C-D and a 36 C-Dare significantly different. Cup size
varies from manufacturer to manufacturer and even within styles from any
particular manufacturer. Nor is there a direct correlation between implant
shape or size and cup size.
Keep in mind that following the advice from a surgeon on this or
any other website who proposes to tell you exactly what to do without examining
you, physically feeling the tissue, assessing your desired outcome, taking a
full medical history, and discussing the pros and cons of each operative
procedure would not be in your best interest. I would suggest that your plastic
surgeon be certified by the American Board of Plastic Surgery and ideally a
member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you
trust and are comfortable with. You should discuss your concerns with that
surgeon in person.
Robert Singer, MD FACS
La Jolla, California
450cc too big ?
Focus on the look not the cc or cup size. Patient's often regret decisions based on extraneous factors as you may end up with suboptimal result. Bra's vary from store to store, and cc's mean nothing in isolation. You should be measured during your consult and offered implants within a 5mm window of those measurements in multiple styles. For what's its worth, in my experience a dimensionally sound mod+ profile tends to go from an A+/B- to the magical full C or small D. A high profile (or SRF) would be about 100ccs larger to maintain the same base width and more like a Full D but VS will call it a DD or DDD, particularly in a 32-34. Ultimately, try on the different styles and look in the mirror. When you see the look you like, pick that style! This requires a consult, exam, measurements and sizing with a board certified plastic surgeon. My patients select the implant style and their chest dimensions dictate the number of cc's. I make specific recommendations to each and every of the augmentation patients I see annually based on: 1) dimensional planning 2) expressed goals 3) amount and quality of tissue to hide the implant. I have included a link with my explanation of the different implants and what to expect from your consult as well as hundreds of before and after photos to see what change implants of a particular size deliver. Best of luck. #drfeldman #BancroftFeldman #breastaugmentation #sugarland #HoustonTX
450cc too big ?
The key to choosing the correct size for you involves matching your breast dimensions and your desired post-op appearance to the implant. Without an exam and measurements, it would not be wise to give a recommendation. However, I will say that I have had patients with your height and weight that have decided on 450cc's, and they have been very pleased with the result. I would recommend trying on the implants with a sports bra so that you get a visual of your post-op appearance. Good luck!
450cc breast implant too big ?
Yes, if you are concerned 450cc is too big it probably is. The implant size should be based on the base width of your breast. Please read the link below:
Thank you for the question. 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, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Given that your surgery is coming up soon, I would suggest that you spend additional time communicating your goals/concerns directly with your plastic surgeon, preferably prior to the date of surgery.
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 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. 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/video, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.