I have always had natural 32DDD, when pregnant went up to a G, post baby still a 32DDD what size implant do I need? (photo)

Thank you for your question. Yours is the quintessential question of breast augmentation with  implants; how big is big enough, and how big is too big. There is never a completely right or wrong answer. This is something you will need to discuss with your treating board certified plastic surgeon. He or she should be able to guide you through the process of what is right for you.    From your picture, it does appear that you have ample breast tissue. In my opinion, there is no question that you need a breast lift. However, the breast implant is optional. If you wanted to be bigger (not your desire), you would need a breast implant. If you wish to remain the same size that you are in a bra, just be more perky then your pregnancy has left you, you could just do the breast lift alone. If you want to be about the same size, maybe slightly larger, but with a fuller rounder upper half of your breast, you could use a small implant to accentuate that while removing some of the saggy breast tissue below your nipple with the lift so that you can remain about the same size. In order to remain about the same size, you will probably need implants in the 200cc range. If you are okay with being a little bigger, you might go up to 300cc. With these size implants, your treating plastic surgeon would need to be comfortable removing a significant amount of breast tissue when preforming the breast lift to remain near the same size as before surgery. I hope this helps. I suspect you will have a great result. 

If you are already a DDD, you do not need implants but you do need a lift.  The technique I recommend is 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.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief and long term stability.  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.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Great question!  Its hard to provide a good recommendation in this type of forum because we don't have the opportunity to find out what your exact goals are and what look you are going for.  Also we do not know what your breasts look like at the moment but you seem to have very large breasts.  If you don't mind being just a bit smaller, then having a breast left only maybe the answer for you.  A breast lift will shrink you down about one cup size so if you are happy with a DD then this maybe fine.  If you desire increased fullness to the upper chest, then you may need an implant - sizing will depend on your breast measurements.Best of luck and hope this information helps!
- Dr. Roger Tsai  @DrRogerTsai
Board Certified Plastic Surgeon

Dear One happy Mom,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift.
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

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  Based on your photographs, the best shape and contour could be achieved with an implant and a breast lift. A large part of your breast sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A breast lift with an implant can result in a very nice shape if good technique is used.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  

Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

If you are satisfied with your size you can just get a breast lift. I sometimes do an auto augmentation of the upper pole using your own tissues. See video (graphic). If you want to increase the volume and don’t want to be too big. Find a bra that you want to fit into, then you can see what volume implant it takes to fill the bra. That would be the size of the implant you need to achieve the right volume in your breasts..

Thank you for the question and photo. From reviewing your photo you may benefit from a small implant and a breast lift. In our practice pts try implants to see which one they like. It is best to discuss this with your board certified plastic surgeon. Good luck.

You have described yourself well, except for the fact that at this weight after babies, you are really a C cup worth of breast tissue. There is no benefit you  to being large than a 34D. If larger, you will look topheavy and unnatural, unless you want that. See a board-certified plastic surgeon, and use Vectra imaging to determine the diameter and projection of implant that you want. Big will not make you look young, it will make you look middle-aged.

Lori L. Cherup MD, FACS

Thank you for the question and photograph.   Based on your photograph, I think that you will do well with breast augmentation/lifting surgery.  Some general thoughts may be helpful to you:
  Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
Also, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars and/or implant exposure. .
 
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting 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. Again, 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 "D or DD cup" or "heavy chested" 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. The use of computer imaging may be very helpful during this communication phase.
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. The use of the tailor tacking technique and the use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
Best wishes.

Hi and welcome to our forum!
From your photo (which can be deceiving), it does not appear that you are DDD....
Determining the “perfect” breast size before a planned breast augmentation is quite a difficult task. Each individual has a different concept of “normal” breast size. In addition, there is no standardization of bra size in the manufacturing  industry. One company’s “C” is another company’s “D”.

There are various ways to determine desired breast size. Bringing in “wish pix” to demonstrate to your surgeon will make him / her aware of your anticipated goals.  Placing an implant in a bra gives an extremely rough idea of anticipated breast size. It may be easier to estimate volume by adding rice to a baggie ( 1 cc 1 ml) and adding the volume to your breast beneath an oversized bra. Some surgeons offer computer imaging.

The most important measurement is the base width of the implant. If you drop a vertical line from the medial most and lateral most aspects of the breast, and measure the distance between them, this suggests a base width. If an implant is too narrow, you will not have adequate cleavage. If wider than the base width, you will have excessive cleavage and “lateral boob”.  The fill of the implant then determines the amount of forward projection.

I recommend a thorough discussion with your plastic surgeon to ensure that you are both on the same page.

Best wishes...