Is Vectra 3D accurate? Are my breasts going to be this far apart and sitting so low on my chest? (photos)

Dear Graceful226977,
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

Good afternoon,I perform 500 augmentations a year and I think Vectra is a waste of time- it's just a marketing tool. However, no one needs Vectra to be able to tell you that with your wide gap, and unwillingness to do a lift, and selection of a very small implant, your gap is going to remain way too wide. So yes in this case Vectra is accurate. I think you should consider at least a larger, wider implant to fill in the gap, if not a donut mastopexy as well.

While Vectra imaging is not perfect, I find it to be a big advance in communicating with patients and it really helps with expectations, such as in your example.    You might be able to get a little more cleavage, but the photos should help you understand some possible limitations due to your anatomy.    In terms of size selection and profile implant, I have found it to be the most useful tool.   You may wish to look at some larger sizes to see if it gives you more of what you are looking for.   

Your breasts are low on the chest wall and far apart.  Implants will not change their position.  Instead, I recommend a simultaneous lift.  You have 2 alternatives: one procedure is a circumareola approach, which is a modified Benelli to reshape and reposition your breast tissue.  At the same time, small implants can be placed.  The other alternative is a breast 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 (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Hello and thank you for your question. Vectra 3D is an approximation, but does not accurately show what each surgeon can achieve. I think you may need a larger implant to give you better cleavage.  I have patients bring in photos of what they hope to look like and then I let them know what implants would be of benefit and whether or not they would need a lift (I don't think you need a lift). I also have many implants from the 3 big companies in the US and I have my patients try on the actual implants to see how they fit their body; I then use Vectra to give them another visual aid to help in the decision making process. I hope this helps and if you're still not certain of your surgeon's recommendations, I encourage you to seek the expertise of a board certified plastic surgeon with expertise in breast revision surgery.Sincerely,Dr. Sean Kelishadi

Imaging programs go only so far and are not a substitute for clinical judgment and experience. The distance between breasts is anatomical although implant base measurements can be of significance.

Thank you for the good question.
 Generally speaking, although useful as rough guidelines and as communication tools, all the modalities currently used to predict what breast implant size/profile will best achieve a patient's goals with breast augmentation are NOT very accurate, in my opinion. The use of the rice test, sizers placed beneath a patient's bra, goal pictures, computer imaging technology… are all useful, but NOT necessarily as accurate as one would hope.  All of these modalities are simply communication tools, not accurate predictors ( or "guarantees") of outcomes.
In my opinion, nothing will replace careful verbal preoperative communication with your plastic surgeon, preferably in front of a full-length mirror along with the use of as many "communication" tools” listed above.
In my practice, I use all of the above modalities and then use intraoperative temporary sizers to help determine the best breast implant size/profile to achieve a patient's specific goals as closely as possible. For this reason, I think it is helpful to have the entire range of breast implant sizes/profiles available in the operating room.You are correct: every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery.  Other factors involved include surgeon dependent factors: for example, careful breast implant pocket dissection and careful selection of breast implant size/profile.  Remember (when it comes to breast implant pocket dissection and achievement of ideal breast implant cleavage) that each nipple/areola complex must be centered on each breast mound.

 Achieving realistic expectations prior to proceeding to the operating room is also an important part of the preoperative communication process. Patients should be aware that the results of their breast augmentation will not necessarily match exactly what they are visualizing with anyone of the above-mentioned communication tools.
 
Given your questions and concerns, I would suggest that you schedule additional time to spend with your plastic surgeon. This additional time spent will be helpful in the communication process and in alleviating some of your anxiety (and help you decide whether to proceed or not).
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 "C or D cup" 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.