Nerves and Sizes? (photo)

I am currently a deflated 32C. I have a narrow rib cage (30.5in). Formally I was naturally a small D cup before I nursed both my kids. I am 5'5 and 122lbs. I'd like to be a D cup again. My ps said 400-450cc. Does that seem large if I am already a c cup? Also I am very nervous to go under general and my ps will only do general (not local like I was hoping). I know the statistics but somebody has to be that 1 out of 220000...what can ease my fears? My ps had been very reassuring and I do want it!

Doctor Answers 15

Good plan for breast augmentation to accomplish stated goals

If you are currently a C cup I am sure that you do not fill up the upper portion of the bra cup.  A 400 to450 cc implant will increase your breast size at least 2 cup sizes.  In my estimation this should accomplish your goal of  being a D cup.  You appear to have a narrow chest circumference and some discussion should be had with your plastic surgeon concerning the use of either moderate plus oar high  profile implants.  The high profile implant will allow you to use a larger implant without the base diameter getting too large.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Is a "deflated C cup" the same as a B cup?

Bra sizes are so subjective between manufacturers that discussing breast augmentation goals and implant choices based on "cup size" is often difficult. Typically, 400-450cc will add just under two cup sizes to whatever breast volume you started with, but personal examination and determination in the operating room is always superior to online size discussions. 

Understanding that all of us online consultants lack personal physical examination, you seem to be on the right track. However, you could easily go with 500cc implants and likely not be overly large for your D-cup goals.  Bear in mind the most common reason for re-operation is "too small"--this supersedes bleeding, malposition, capsular contracture, infection, etc.--so getting size as close to your goal as possible is critical to avoiding another operation, especially if concerns about anesthesia are also an issue. 

Bringing goal photographs to your surgeon will help in proper implant selection, and having all implant sizes and profiles available (rather than just a few choices that are "ordered in advance") is one characteristic of a surgical practice that does a lot of breast surgery. For example, we maintain a complete inventory of implants in all sizes and profiles in our on-site nationally-accredited (AAAASF) surgical facility, so we do not need to order in advance, nor do we fail to have the "right size" should our decision change during surgery.

As to anesthesia concerns, you need to understand that local anesthesia is not "safer" than skillfully and expertly-performed general anesthesia, especially if your surgeon cannot concentrate on performing the best and safest operation in a completely-asleep, fully-monitored, immobile patient. Local anesthesia requires at least some IV sedation, and this requires monitoring for optimal safety, so you are not saving money, nor are you necessarily receiving "less medication." We have offered all types of anesthesia (local, local plus oral or IV sedation, MAC--monitored anesthesia care; not completely asleep, and full general anesthesia--TIVA vs. inhalation) in our facility for over two decades, so we have experience in all of these modalities, and can assure you that many local with IV sedation cases actually require more medication and have more nausea and vomiting than a properly-performed TIVA anesthetic.

Truly, risks are lowest if performed in an accredited facility by experienced anesthesia providers, and I personally believe many plastic surgeons (myself included) who operate in their own facilities can offer a superior experience compared to a hospital or free-standing hospital-affiliated surgicenter, not to mention avoiding sick patients and nasty bacteria!

I also believe that I can do a better, more-precise, and lower-risk operation when my patient is completely asleep than when I'm faced with a partially-sedated patient who may move a bit, whose blood pressures are higher causing more bleeding and bruising (and risk of capsular contracture), and may feel discomfort if the local is not complete, or the sedation a bit light. Your surgeon obviously feels the same way.

Ultimately, it sounds as if your surgeon is making good recommendations, and you should have already checked credentials of the surgeon and the surgical facility (and anesthesia provider), so rest easy and you will do great. Patients who are confident and motivated do better than still-anxious worried patients, so try your best to lay your concerns to rest beforehand.

"Butterflies" are OK, but be assured in your choices and your surgeon's skills and recommendations. For more information about TIVA anesthesia, click on the web reference link below. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Nerves & Sizes

Based on you on your photos and questions, it appear that you have a good plan.  General Anesthesia is extremely safe and a better choice. The size you discusssed with your surgoen should work.  Best wishes!

Robert F. Centeno, MD, FACS
Columbus Plastic Surgeon
4.9 out of 5 stars 77 reviews


Thanks for posting your concerns and photos. All of my patients have similar concerns about sizing and the anesthesia. In our practice, we use a board certified anesthesia MD and a certified facility to perform your operation, meeting the highest standards. Breast surgery is considered very safe. Your smaller frame could handle a bigger cup size, but a recommendation can only be achieved via a full consultation. The sizes you have mentioned seem reasonable given the goals you have set for yourself. Best wishes, Dr. Aldo.

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 202 reviews

Choosing Breast Implant Size

It is always a bit of a challenge choosing implant size but there are lots of tricks!  First of all, I think this size range will look great on you!  It is impossible to figure out EXACTLY what bra size you will be since no amount of cc's correlates with a bra size.  Second, all bra makers are different and so I'm sure you know that even now you wear one size at Macy's and another size at Victoria's Secret.  I have the most luck with my 3D imaging to pick size.  With this program you can take pictures and create a 3D image and then "try on" different size implants.  Then you can look at the results with and without clothes on.  I also have sizers in the office to try on under your clothes.  I always think that if you love what you look like with a certain size implant, then who cares what bra size you are!  Good luck!  K. Roxanne Grawe, MD Columbus Plastic Surgeon

K. Roxanne Grawe, MD
Columbus Plastic Surgeon
4.9 out of 5 stars 137 reviews

Proper Implant Selection

Thank you for sharing your photos.   In terms of anesthesia, I find the operation goes smoother with less discomfort under a general anesthetic, compared to local.   Many patients do not want to feel the tugging and pulling sensations that occur with local and prefer to just wake up and not feel anything.  I find general anesthesia to be extremely safe in this 45 minute procedure.    

In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.
Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 86 reviews

Upcoming breast surgery

From your three consecutive questions in this forum I have to think that you are still very, very nervous about the upcoming procedure. Even though none of us here and your surgeon can take away all your fears your chances to be excited about your result is just  so much greater than your fears.

You have to be comfortable with your surgeon, ask him all the questions you may have and make sure that he answers them. On the other hand he is your surgeon and  "expert" and you have to let him do his work so he  can achieve the result you want. That means  the safest and most efficient way he knows. This applies also to the brand, type and size of the implants.

Guido P. Gutter, MD
Evansville Plastic Surgeon
4.9 out of 5 stars 18 reviews

Nerves and Sizes?

That's a fairly good sized implant on your frame, though you may have room for it.  I suspect that you're a C mostly because you have some excess and loose skin that needs to be "held" by a cup that large.  If you could assess only your breast tissue, it looks like you're more like a full A or small B.  That sized implant would, therefore, give you the D you want, so it's not unreasonable from that standpoint.  Talk to your PS about the potential need for a lift at some point, depending on how large you decide to go with the implants.  Finally, this procedure can be done under several different forms of anesthesia but I would advise that you accede to your surgeon's recommendations.  If you're set on a specific form of anesthesia and your surgeon does not do that, for whatever reason, you should consider a different surgeon.

I hope that this helps and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Nerves and Sizes

It is normal to be anxious prior to surgery but your plastic surgeon should be able to reassure you so that you will be less prone to panic.  As for size , you will probably need something in the 450 cc or higher range with a high profile.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 109 reviews

Size and Nerves

By what I can see of your pictures, that size looks reasonable. you definitely will not be a full "D".  As far as the anesthesia issue, having surgery with a general anesthesia is the safest way to go.  Keep this in mind....Your surgeon wants to be able to do his/her job and give you the best possible result.  When you have a local with such a surgery the surgeon has to do two jobs. Not only the surgery but also to make sure you are numb enough as well as keep track of vitals, etc. When you have an anesthesiologist working in conjunction with your surgeon, he/she is monitoring you every moment of your surgery. Make sure you do your home work.  Both surgeon and anesthesiologist are Board Certified and the facility is accredited and reputable.  Good Luck to you!

James E. Murphy, MD, FACS
Reno Plastic Surgeon
5.0 out of 5 stars 32 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.