Perky, full breast augmentation. What is the best implant and incision?

I am 5'7 and 105. Right now I have A cup. I wanted to know on normal what is the largest you can go? I do want to keep them high and close together and leaning towards gel silicone since there are less complications. What are the major things to know? What are the best questions to ask the doctor for consult. Thank you.

Doctor Answers 11

What's best for me?

How to Pick the Right Size and Shape of Breast Implants 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.

Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Perky, full breast augmentation. What is the best implant and incision?

Thank you for your questions regarding breast augmentation.  The implant of choice will depend on your postoperative goals and the measurements of your breasts/chest.  Your surgeon should discuss with you the differences between silicone and saline implants, round vs anatomically shaped implants, submuscular vs subglandular implant pocket location, and incision locations.  You should also expect to be able to use a sizing system of some sort in your surgeon's office so that you are both on the same page as to your postoperative expectations.  Based on your height and weight, I would expect to place your implants in a dual-plane submuscular pocket and likely through an incision in the fold under your breasts.  To be sure, consult with one or more board certified plastic surgeons to discuss your options.  I would be happy to see you for a complimentary consultation.  Best wishes!

Nicholas Tarola, MD
Nashville Plastic Surgeon
4.9 out of 5 stars 57 reviews

The right implant

Your question is a great one. It depends on the look you are trying to achieve and your breast characteristics. A good start will be for you to look at pictures on someones website and choose a look and size that may match your own. Seek a consultation with an experienced board certified plastic surgeon. Make sure he offers all the implants out on the market as it will give you a wide verity and will show your surgeon is a talented one that knows what he is doing and offers variety to his patients. Ask about the positives and negatives about each implant. Have a physical exam done by him. See a few surgeons prior to your surgery. There are so many types of implants with different gel, profile, shell etc. to choose from.

Good luck! 

Best Implant and Incision for Perky Full Breasts

There are so many options including the implant size and projection as well as your breast base diameter and skin elasticity.  You really need a thorough consultation with an experienced, board certified (ABPS) plastic surgeon to help you make these decisions.  In general, I would recommend a gel filled high fill volume implants such as the Natrelle Inspira implant.  Given your height and weight as well as your desire to have full breasts, I would recommend a full or extra full (high) projection implant. The implant base diameter should be roughly the same as your breast base diameter. As for the incision, different surgeons have different preferences, but the majority prefer an inframammary incision. These decisions will be made during your consultation.  

Laurence Weider, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 98 reviews

Perky full breast augmentation

Thank you for your question.  Because of the sheer variety of implant styles, sizes, and types it is difficult to recommend a specific one as key breast measurements of your chest need to be made, and an in-depth discussion of your desired goals needs to be had.  All things being equal, I would recommend seeking a moderate plus or high profile implant with greater silicone "fill" such as the Natrelle Inspira or Sientra implants to attain a full, perky appearance.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 65 reviews

Breast augmentation

What you are describing could be accomplished with a high profile implant.  You want to make sure the base diameter of the implant matches your base diameter.  I recommend the Allergan Inspira extra full profile implant.  I would also recommend doing 3D photographic imaging to visualize what a specific implant would look like on your body.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 42 reviews

Breast augmentation questions

So much of what you are asking can only be determined with anti person examination. How big you can go, which implant, how close together they will be all depend on where you start. The most important thing to do before your consultation is do your homework. Check your surgeons websites. Make sure they are a Board Certified Plastic Surgeon, not a board certified ER Doctor who puts in breast implants for cash. Check their before and afters and look for patients similar to you. Smart Beauty Guide is a excellent resource to look for local board certified plastic surgeons who also are members of our aesthetic society. 

Main Nashville there are many outstanding plastic surgeons who do excellent breast surgery. You should see 3-5 and pick whomever is not only qualified but that you feel comfortable with. No one plans on a complication, but you want a doctor you trust if that happens. Best of luck 

Melinda Haws, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 44 reviews

Perky, full breast augmentation.

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” or "perky,full" 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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

BA Implant type and Incision Location

Hello and thank you for your questions. I wish you the best in finding the right answers and there are a lot of great answers and information on the forum as well as on my website. Remember, it is best to see a Board Certified Plastic Surgeon who can in person examine you, take key measurements and go over with you your specific aesthetic goals. Bringing several photos of your "ideal" look can be helpful as well. My consultation is done at no charge, and with the consultation is a review and discussion about several things including incision location, implant placement, implant size, shape, type as well as the expected recovery period. I take personal care of all my patients to ensure optimum results. There are several key differences and some similarities in the types and shapes of breast implants. It is best to see and feel in person the different sizes, shapes and textures of the various implants during a consultation with a Board Certified Plastic Surgeon. Best of luck.

Benjamin J. Cousins M.D.
Board Certified Plastic Surgeon

Benjamin J. Cousins, MD
Miami Beach Plastic Surgeon
5.0 out of 5 stars 10 reviews

Perky, full breast augmentation. What is the best implant and incision?

Sizing of breast implants will be determined by the width of the base of your breast which will be measured by your surgeon during your consultation. For more information please read the link below:

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.