38C, I want them to be fuller up top without having to go bigger than a full D. What CC is recommended? (Photo)

Question

How many ccs to get a fuller more proportionate look after reduction 5 yrs ago. I want to look full in a triangle him in and naked. I am muscular and wide built so I don't want to go too big. I just want fullness up top and for my size to more fit my body. Any other recommendations as well?

Stephen M. Krant, MD, FACS · Answer

Your breasts look excellent 5 years after the reduction mammoplasty. To gain fullness superiorly, a high profile prosthesis can be placed sub-muscular and centralize it to give more upper pole fullness.
It is hard to determine actual implant size by the photo. Whenever I perform a primary augmentation or secondary reconstruction, as in your case, I never tell the patient the specific size will be used. A full "D" on your body is determined by chest circumference (38), amount of existing breast tissue, and the degree of the pectoralis muscle. I use sterile sizers to be placed during surgery, so I can make a more specific size (prosthesis) determination. Then, I place the new prosthesis. Also, consider tightening the skin envelope with a secondary mastopexy.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I discuss goals and measure a patient, we then look at pictures of women with similar measurements with different size breast implants. My patients tell me that this process is very helpful in determining what size implant is best for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Daniel Barrett, MD · Answer

Hi RELong,
  
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

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation to add upper pole fullness.  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

Gary M. Horndeski, MD · Answer

At size 38 C each 200
cc corresponds to 1 cup size change.  An
alternative to consider would be a revision of your previous Wise pattern with fat
transfers of approximately 300 grams. 
This may give you the look you want without the future complications of
implants.  Best Wishes,Gary Horndeski, M.D.

Nelson Castillo, MD · Answer

Thank you for your question and photographs. Breast implant selection is an exciting, but stressful part of the breast augmentation process as there are so many choices. Unfortunately it is impossible to recommend the best implant style, size or shape without an in-person examination that allows for the measurement of key breast parameters, as well as permits an in-depth discussion as to your desired goals and outcome. I would recommend seeing an ASPS board certified plastic surgeon, they are in the best position to ensure that the implants the two of your decide upon are the right ones to meet your expectations. It sounds as if it may be wise for you to "try on" several of the implants so that you can have a better visual representation as to what they would look like. As far as the implant I would recommend a high-fill silicone gel such as the Inspira line. Best wishes!

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look.With regards to your specific question, your goals seem reasonable. I would begin with your measurements (BWD). On a wider frame, a moderate (+) device is usually adequate for achieving most goals especially if there is not a desire for a significant volume upgrade.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Mark Deutsch, MD, FACS · Answer

Thank you for your question and sending your pictures. It is difficult to determine implant size without the benefit of an exam, it is best that you meet with a board certified plastic surgeon and they can give you sizers that you can use to help with your implant selection.  You may also want to look at both shaped and round implants and discuss the pros and cons of each.

Ven Erella, MD · Answer

Thank you for your question. Implant size depending on breast measurement, your anatomy, your goals etc. Please consult with a board certified PS for evaluation and to discuss your goals.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.   However, careful physical examination and communication   of your concerns and goals will be necessary to determine whether additional "lifting" (as well as augmentation) would be beneficial when it comes to achieving an outcome that you will be pleased with. 
  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. Sometimes, it is necessary to seek several consultations before you feel comfortable about your choice.
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. I have found that the use of words such as “natural” or "full D cup” etc may mean 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, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size. The use of computer imaging may be very helpful during the communication process. The use of in bra sizers may also be helpful. In other words, use as many “visual aids” as possible during the communication process. I encourage patients to meet with me as my times as necessary, to feel comfortable that we are both on the “same page”.
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. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.
 
I hope this helps. Best wishes for an outcome that you will be very pleased with.

38C, I want them to be fuller up top without having to go bigger than a full D. What CC is recommended? (Photo)

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