My Ps Said He Could Go No Bigger Than 400cc Saline Implant on my Frame? Why? (photo)

My breast augmentation surgery date is on halloween, and i am extremely anxious but scared im going to small... :( My stats are 31" rib cage, Weight:128lbs Height: 5'4" current cup size: full 34A/small B. My ps sized me at a 400cc saline implant and I asked if i could go bigger he said no. I would like to be a full D+. I thought I had some input of what size I want. He didn't even ask what size I wanted to be post-op. Should I trust this ps???

Doctor Answers 7

Choosing Implant Size

Choosing implant size is very complex and involves discussion between you and your surgeon. You should have a great deal of input.  Your surgeon may have reasons for not recommending over 400cc, and they may be valid, but you should be clear about those reasons. If you feel as if your surgeon and you are not on the same page, you should find another surgeon.  After the surgery, it is too late to change your mind. This is an important decision and you should be 100% confident in it! Maybe you should find another board certified plastic surgeon for another opinion before it is too late to turn back. 

Implant Sizing

This is the approach I use to help guide my patients with their implant size selection:  I consider two factors when selecting implants for my patients:

1.Dimensional planning
2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.  If you have decided on saline implants, then based on the gel sizer you select, we can guide you to the saline implant that achieves a similar look.
Hope this helps.
Dr. Basu
Houston, TX

Breast augmentation and appropriate size

Thank you for posting your photo, as well as providing additional information. It appears that your right breast is slightly larger than your left breast and it seems like you may like to have larger than natural looking breasts. In order to suggest the best and most attracive natural looking breast to meet your expectation, it is a good idea to ask your plastic surgeon to measure the base of your breasts and inquire if he/she would consider to put different size implants for bring them into more symmetry. Each cup size is approximately equal to 200 cc and if you like to get two cup larger you may need at least 400 cc implants. My first choice is silicone implants and there are ways to assess what size implant would suit you before your anticipated surgery.

Fereydoon S. Mahjouri, MD
Minneapolis Plastic Surgeon
4.9 out of 5 stars 16 reviews

Breast implant size

So far it looks like a good plan to me. Any larger would be too wide for your frame and more risks of wrinkles. You will be DD all day long. Good luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 53 reviews

My Ps Said He Could Go No Bigger Than 400cc Saline Implant on my Frame? Why?

Without an in-person examination, it is hard to give specific advice on implant size. However, if your surgeon is experienced, they he knows what can happen if you go too big. While you may be scared about "going too small", he may be watching out for you so that you don't go too large and stretch your skin out too much (which is hard to fix).

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 63 reviews

My Ps Said He Could Go No Bigger Than 400cc Saline Implant on my Frame? Why?

Despite good intentions, online consultants will not be able to provide you with  meaningful specific advice.  Ultimately, in person consultation with well experienced board-certified plastic surgeons will be necessary. Careful measurements, dimensional planning, and careful communication will be key.

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're 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 which operation and/or 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 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, helps.

400 cc implants retro-pectoral will extrude inferiorly and laterally

If you are 34 A each 100 cc’s of implant corresponds to 1 cup size change.  To achieve a D would require 300 cc implants.  Certainly, 400 cc implants is more than enough to achieve that.  However, I always recommend silicone gel implants placed retro-pectoral since they look and feel more natural, are more stable, less likely to ripple or have complications needing revision.  I doubt that you could accommodate 400 cc implants retro-pectoral since you are small and they would extrude inferiorly and laterally requiring revision.  Also, your photograph shows asymmetry and your breasts are far apart.  A simultaneous lift is just as important as breast augmentation.  There is a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Through the same incision, implants can be placed.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant. 


Best Wishes,


Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.7 out of 5 stars 208 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.