What is the best implant for deflated breasts after nursing 4 babies? Are my wish pics possible?

Question

I am 32, 5'4" 118 lb and have nursed 4 babies. Now that I have stopped nursing, my breasts are deflated, seem to be more wide spread and my nipples/areolas are bigger and indented. My surgeon said that I don't need a lift and suggested using mod profile implants. I'm thinking 405cc or 445ccs? I have a small chest (28") but a fairly large BWD. I hope to fill up the emptiness I have & gain some roundness. In your opinion, are these results possible and what implant do you think may achieve this?

Ellen A. Mahony, MD · Answer

The best thing to do is try on sizers to get an idea of implant size and shape relative to your chest dimensions and your overall body proportion.  When there is significant volume loss and a lax skin envelope (like you), the implant will sit fairly superficially, even if it's partially under the muscle. You may find that a smaller implant can give you a good amount of shape and volume AND have greater longevity due to being lighter weight.  See web reference.Keep in mind that the bigger the implant, the faster they fall.  On someone your size, that's a lot of volume and weight for your upper half.  Thus,  about 50% of the women in the photos that you displayed will be doing a revision of some sort in the next 10 years.  What may look sexy for a brief moment at 32 years old, will soon move onto looking matronly...and no woman ever wants to look like her mother...right?!  Think of the investment your making, try to strategize long term, not just for the moment!In good health,Ellen Mahony, MD

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. You appear to be an excellent candidate for breast augmentation surgery. The proper implant must be selected to fill your skin envelope. Please have an in-person examination with a board certified plastic surgeon who specializes in cosmetic breast procedures. Ask to see a lot of before and after photos of what can be achieved with implants. Hope this helps and good luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  405/445cc may work for you, but it truly depends on your individual breast measurements.  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. 
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Gregory T. Lynam, MD · Answer

I would consider saline  moderate plus or high profile implants for the look you desire. One could use high profile silicone as well. I use a small one inch incision under the arm pit area for the saline implants. While very board certified plastic surgeon will have a different plan and size for you I think your goal pic but a bit smaller looks reasonable based on your current pictures. Good Luck!

Ram Kalus, MD, FACS · Answer

Your story and photos suggest that you would be an excellent candidate for breast augmentation but precise information or recommendations can only be determined with a careful examination and detailed discussion with your plastic surgeon. Volume (300 versus 400), is far less significant than implant width and projection. Saline versus silicone is also important, as is "round" versus "anatomical" or "form stable" or "shaped". 
It is crucial that you select an experienced board certified plastic surgeon whose aesthetics align with your own, and with whom you feel comfortable. Don't be reluctant to seek a second or even third opinion to be sure and feel confident. Make sure that your surgeon sees photographs of your "favorites" or ideal. Expressing your desired cup size is notoriously inaccurate, and final breast size is the most common reason for patient disappointment after breast augmentation, either too big or not big enough.
The good news is that from your photos it appears that your breasts are pretty and fairly symmetrical, which is always a good starting point. 
Take your time, do your research. Best of luck to you.
Ram Kalus MD

Ricardo Ventura, MD · Answer

Hello and thank you for your question and images. To obtain the ideal implants I recommend having a personal consultation  with a board certified plastic surgeon. And have a discussion about your goals and desires.

Steven Wallach, MD · Answer

Choosing the right implant for you requires an exam in person and a discussion of your goals. Without doing that, it is difficult to suggest an implant for you.

David A. Sieber, MD, FACS · Answer

Thanks for the great question and the photos. Your breasts don't look exactly like the breasts in your wish photos, but you should still be able to get a very nice outcome. Since you are so small with a narrow chest, but you still want a fair amount of volume, I would talk to your doctor about a higher profile implant. I think with the moderate profile implants you will end up with too much of the implant in your armpit. The most important part of breast augmentation is making sue you have an implant which fits your anatomy. That's why it is so important to make sure you have all of your breast measurements taken and an implant is chosen off of those. Best of luck!~Dr. Sieber

Stefan Rene Adair, MD · Answer

First you should consult with a board-certified plastic surgeon. The changes in your breasts are normal postpartum. I would recommend using gel implants beneath the muscle through a fold incision. Appropriate size will be determined during your consultation with the surgeon, and viewing of before and after photos of similar patients.
Best of luck.

Brooke R. Seckel, MD, FACS (retired) · Answer

Congratulations on your decision to have breast augmentation surgery.  The size of implant should be determined by her surgeons measurement of the base width your breast.  Your desired result shows very large implants and my guess is that the desired results that she show are larger than 405 or 445 cc.  The problem with very large breasts like you show in your desired photos is that the breast tissues are stretched  and complications such as capsular contracture are more common. You should be able to achieve a very nice result with an implant that is sized to match the base width of your breast.

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