Large framed currently 40C. Planning on lift with augmentation. Would like to go to D/DD. Dr recommends 485cc gel. Thoughts?

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Hello, thanks for your question. Without having examined you personally, I would agree that a larger implant is typically required for larger framed ladies to obtain the same effect. However if you only want to go up one cup size, then you would probably do fine with an implant in the 250-350cc range. If you are concerned with looking fake, then it would be best to stay on the lower end just to be safe. Hope that helps! 

hello thank you for your question and provided information as well;..based in your question its difficulted evaulate your case if the question dont have a picture, its recommended to get a consultation in personal with a plastic surgeon.

Implants are not lifetime devices.  485 cc implants weigh over 1 lb each and will result in descent.  If you are having problems maintaining your normal breasts, adding additional weight will make your situation worse.  The better alternative would be a lift using The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. 
"Too big" is a relative question. The best advice is more communication. As you are the only one who can decide if a chosen implant is "too big" i.e. too much for your desired post op look. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame
 

Thank you for sharing your excellent question.  You are right that based on your frame a larger implant will be required to achieve your goals, but without key breast measurements and without knowledge of your desired results it is impossible to offer you definite advice on size or profile.  I would recommend seeking out more in-person consultations or further communication with your surgeon.  Hope this helps.

Without a picture or an examination, it is impossible to give you any kind of useful feedback regarding size.  This is a question that must be addressed in consultation with the examining board-certified plastic surgeon.  Everyone is different so there is no formula that we all use to determine size.  If you have questions, I would recommend that you get a second opinion from another board-certified plastic surgeon who can examine you in person.

Hello,My thoughts are you should eliminate from your mind any concept that a surgeon can pick an implant to achieve a given bra size. It's simply impossible, regardless of what some misguided surgeons might suggest. Instead get sized using purpose built sizers, or make rice sizers, as seen on YouTube. 

It would be helpful to see photograph of your breasts.  There are so many different breast procedures for a lift and implants that it would be impossible to know which procedure would be the right one for you.

Dear  lkw_dvm2010,
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