Will I Notice a Difference?

Question

HI! I had agumentation 10 yrs ago with McGhan Saline style 68 filled to 350cc.Now:two breastfed children later, I am booked for a revision. Although I have sagging (not terrible) I am more concerned with the size so having seen my surgeon he recommended Allergan Silicone High Profile, they are ordering in 400cc and 425cc and based on my breast diameter I cannot go larger than that? I am concerned however, that this may not be enough of a difference in cc even though the projection is changing?

Richard H. Tholen, MD, FACS · Answer

I have said this to so many patients over the 24 years I have been doing this surgery, but there is a reason it needs repeating over and over! 50cc is 3 tablespoons and 1 teaspoon of volume. Put that volume in a glass and try to visualize how much that volume over an entire breast will increase it in size. Barely noticeable at all!

	75cc will be (slightly) visible, but, by my rule of estimating, adds less than 1/3 cup size to whatever breast tissue you have now. This is a critical fact. If you simply use 350cc and increase it to 400cc, this is indeed a 14% increase. But your breasts consist of your own tissue plus implants, not just implants alone! Let's say you have only 250cc (about one cup size) of your own tissue to which the 350cc (600cc total) is increased to 400cc (650cc total). This is only an 8% increase in size! If you do the math for the 425cc implant, the increase (again assuming you only have 250cc of your own tissue, about an A cup) is only 13%. Either of these increases is indeed an increase, but so minimal you would hardly be able to see a difference! If your breasts pre-implants were somewhat larger than A cup, the actual percentage of increase is even smaller!

	As others have said in their answers, you will definitely need more volume to see a visible change. I would argue that it takes about 250cc to equal one cup size, and this is based on thousands of these surgeries. Since I do not charge a surgeon's fee for re-operation (patient pays for OR, anesthesia, and new implants) this is a LOSE-LOSE for both surgeon and patient when size is wrong, so I truly believe this is good advice, and respectfully disagree with my colleagues who are more conservative. Perhaps they charge for re-dos, or work in a university setting with a salary, and have less of an incentive to "get the size right." My reputation and income depend on my having as few do-overs as possible, even for size change!

	At any rate, you might want to read my article (on the "About" tab on my Profile page in this site) titled: "What is the Right Breast Implant Size for You?" for more information. Your hunch is probably right here.

	As an aside, why does your surgeon have to order implants, constraining you to the choices made before surgery, when the best choice in the operating room may in fact prove to be a larger implant? What then? Later re-operation and a re-order of the "correct" size? Who pays for this? Many surgeons who do lots of breast implant surgery have a full inventory of breast implants on-site (if they operate in their own surgical facility as I do). I have every size choice and profile available in the operating room. Sterile sizers can be used to determine the proper size for your post-baby anatomy and your goals for the surgery, and any intra-operative findings that might change your surgeon's mind can be taken care of without the excuse of: "That was all we had available!" Even hospitals and surgicenters have a larger inventory than two choices! (Both of them wrong, IMHO).

	Kyla, listen to your gut! You probably need 500cc or larger to really make a difference. Best wishes!

Amy T. Bandy, DO, FACS · Answer

Going up 50-75cc will likely not give you enough of a difference if you are looking for larger, fuller breasts. In my experience, most patients need 150-200cc to go up a cup size. If you are looking for just a very slight amount more fullness, then the 400-425 may work, but will be minor.

Tom J. Pousti, MD · Answer

Thank you for the question. I think your concerns, given your description of your situation, our valid.  Given the changes in your breasts after pregnancy the larger volume implant and/or mastopexy surgery may be indicated.

	If revisionary surgery is decided upon, it will be very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" means different things to different people and therefore prove unhelpful.
	Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;.

	 I hope this helps.

Steven Wallach, MD · Answer

With a small volume change of 50-75 cc's you willnot see a big change in the overall size of yoru breast. The shape will change a bit, but not the volume. For a noticeable chane, you are probably looking for at least 150 cc's or more.

Bivik Shah, MD · Answer

Picking implant size is one of the hardest things for patients (and plastic surgeons) to do - but you can really pick however full you want to be - there really are no limits. That being said, there are some increased risks to using a large implant - including: faster sagging, "bottoming out", and the possibility of implant malposition. Although we do not know what the cut off number of cc's is, we think it starts around 400cc. Good luck!

Lisa Lynn Sowder, MD (retired) - Account Suspended · Answer

The 50 to 75 cc incease in size is not very much, but most careful observers would notice a difference.  I do not think you should go any larger than what your doctor feels comfortable with on the basis of your breast diameter.  Your anatomy, not your imagination, should be your and your doctor's guide to size.  If you exceed the natural diameter of your chest, your implants will end up in your arm pits or your will get "unaboob" or both.

	 Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder

Robert M. Grenley, MD (retired) · Answer

A size increase from 350cc up to 400-425cc is enough to notice a difference, but it is not a great difference. In fact it is a 14% or 21% difference in size. I tell patients that a 25cc difference is just barely noticeable, 50cc is noticeable but mild, 75cc obviously more noticeable but certainly not a "earth shattering" difference. Of course this generalization depends somewhat on the overall size, since these changes are more significant in patients who have really small implants (eg: 200cc). Anyway, you should also know that large implants 400cc and over may have some longterm effects, particularly in patients with thin tissue, with a higher risk of skin and tissue stretching, higher risk of drop out, etc. You mention that you have sagging, though "not terrible". If by sagging you mean deflation without significant overhang, then a larger implant may be required to fill out this looser skin. If you have significant overhang, you may need a lift, and you should be aware that using larger and larger implants to fill out a sagging, overhanging breast that really needs a lift will take you down a road that you do not want to travel...large implants do not really "lift" breasts, and the longterm problems mentioned earlier (stretching and thinning skin, drop out) are not easily corrected. Discuss with your surgeon (or get a second opinion) whether in fact you need a lift rather than depending on very large implants to do something that they will not in fact do.

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