How to pick the correct breast implant size for a very pear shaped body? (350 cc - 375 cc)

Question

I'm 5' 4'' tall, 140 lbs, rib cage is 31" and my BWD is 11.5/12. I am told that my upper body is quite small (especially in comparison to my butt) - that 375 cc's is my max. Because I am pear shaped, I have always looked skinnier than what I genuinely weigh (my upper half is very thin.) I have researched girls with 375 cc's. While some look huge, others look modest. I am nervous that I will look top heavy with DD's. Why such disparity in how big they end up on other women? Is this a big size?

Daniel Barrett, MD · Answer

Hi freyjabjork,
  
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, MHA, MS
  
Certified, American Board of Plastic Surgery 
  
Member, Am. Society of Plastic Surgery

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  It would be helpful to view a picture of your breasts in order to help determine if 350-375cc is a good size for you.  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.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Kevin Bounds, MD · Answer

Find a surgeon who will examine you, listen to your concerns and answer them from experience. A number is just a number, with experience and by understanding your desired result, a board certified plastic surgeon can very likely achieve your goals and address your concerns.  Bring in a photo that demonstrates both your desired results and those you do not like. This can be very helpful to your surgeon in trying to make you happy with your results.

Paul Jason Skoll, MBChB, FRCS, FCS(SA)Plast · Answer

Hi. The short answer as regards the volumes you suggest (350-375) is that there is very little in it. In my practice, I use 3 elements to arrive at a suitable size range for any given individual.  Each patient is asked to try on "testers" (sample sizers) in the office in a bra  and show me the look they prefer with a sizer in a bra on one side. Secondly, this is then correlated with breast base measurements - the pre-operative breast base width being the most critical measurement, as this determines maximum implant base width for any given individual. So the patient can usually choose the desired implant projection, but not the width as this is decided based on existing anatomy. Other factors like whether the breast is firm or deflated, stable on the underlying muscle or loose are also taken in to account. Finally, a range of implants (each with a tester) is made available in the operating room, where final intra-operative sizing is done (based on the pre-op discussions, measurements etc) and an implant in then chosen at that time. I usually have 5 implant volumes available - one is the most likely "best fit", but I have 2 smaller sizes and 2 larger just to be certain that I get the best fit for any given patient. Every surgeon has their own system - make sure both you and the surgeon are on the same page!

Tom J. Pousti, MD · Answer

Thank you for the question. You are correct in that identical breast implants utilized for different patients may achieve a very different outcome.
My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
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.
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 words such as “natural” or "D or DD cup” or "top heavy" 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 helps. Best wishes for an outcome that you will be very pleased with.

Steven Wallach, MD · Answer

Choosing the right implant for you requires an exam in person. If you do not want to appear too "hippy" then you might want a wider implant than your base diameter.

Robert L. Kraft, MD, FACS · Answer

There is virtually no difference between the two sizes. 25 cc is the equivalent of a teaspoon.  For your height and weight, either would be an appropriate size and consistent with what I would offer my patients.  It would be helpful to know the profile and where he implantation will be above or below the muscle. Best wishes.

William B. Rosenblatt, MD · Answer

If you want to know how you will look with different size implants then you should go to a doctor who uses Crisalex 3D imaging were we can take a photo of your breasts and then image them with different size implants. The system may not be perfect, but it is better than guessing. Also you can try different size implants in your bra in the doctors office. Good luck.

Kevin Tehrani, MD, FACS · Answer

Thank you for your question. Based on the dimensions you have mentioned and of course depending on your starting size those implants should be able to fit properly. It is best to have a consultation in person and preferably undergo 3-D imaging to simulate your postop results accurately.

How to pick the correct breast implant size for a very pear shaped body? (350 cc - 375 cc)

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