Wanted to Look Larger. Questions About Implant Size After Augmentation
Re-operation after augmentation for the purpose of getting a different, often larger size is something we would all like to avoid, particularly the patient. Using some objective method, such as the Tebbets High Five System, would go a long way to avoiding this if it was more widely practiced. Taking into account the nipple to fold distance, and the base width of the breast, laxity of the tissues, and amount of existing breast tissue allows one to get a result that gives roundness, filling the skin envelope from side to side, and gives upper pole roundness without excessive fullness. Although the wish pics show a result that is quite full and round and not really natural, the pictures shown indicate that the upper pole could be a bit more filled, as the nipple to fold distance is long. High profile implants are narrower than moderate profile, and have a more abrupt step off in the upper breast at the junction with the chest wall; but when a larger implant is desired they do allow more volume in the same breast width. This extra size has long-term trade offs of thinning and stretching breast tissues. Such changes are permanent and can lead to drooping of the breasts, atrophy of breast tissue, and the need for a lift later.An in person examination and measurements are needed to really answer your question about optimal size.
It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon.
I want to go bigger. 500-550cc??
From your photos, it appears that it would be possible for you to increase the size of your breast implants by 125 to 175 cc. This 33+% increase should be notable and should put you in the range of your "wish" photos. Best wishes, Dr. Lepore.
Hello,That represents a 33% to 45% change, which should be adequate to achieve your goals. However, I recommend capsulorrhaphy to reshape and tighten the capsule so your new implants sit higher and closer together. If your surgeon isn't a ABPS certified/ASAPS member surgeon who specializes in revision surgery, you may want to visit a few.Best of luck!
I want to go bigger. 500-550cc??
Dear kattherreraI I agree that by increasing the size by 125-175cc you will have a noticeable difference in your breast size. You can discuss implant shape with your surgeon as that might help to reach the results that you prefer in conjunction with the increase in size. The surgery itself is usually less painful than the first time and your recovery will likely be easier.
I want to go bigger. 500-550cc??
You should have a noticeable difference by increasing implant size 125-175cc. You likely need to use an ultra high profile implant so that your implants do not push too far out to the side.
Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery
I appreciate your question.
The size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve. If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.
Silicone will give you a fullness at the top (upper pole fullness).
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.
Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
Best of luck!
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute
Thank you for your question and providing photos. I do believe the volume increase will be noticable. When a patient wishes to go larger I generally recommend an increase of at least 150 cc's. Your current implant appears to fit your chest well. Based on your wish pic's you might consider switching to an ultra high profile implant which will give you more projection and the volume you are thinking about. Best of luck
I want to go bigger. 500-550cc??
That volume difference is significant and should get you in the range you like, but I think your implants are too low, resulting in too much skin below the nipple and lack of upper fullness to the breast contour. You may need to consider a capsulorrhaphy also. It would take an exam to be sure.
Best breast implants for me?
Thank you for the question. Although it is not possible to provide you with definitive advice without an person evaluation, most patients are able to "go larger" at a second stage, once the breast tissues have expanded (after first-time breast augmentation). Sometimes, during this revisionary surgery, adjustment of the breast implant capsules is also necessary to achieve the desired outcome.
You will find that online consultants will not be able to provide you with specific advice in regards to selection of specific breast implant size/profile.
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, and computer imaging) will be critical.
Generally speaking, the best online advice I can give to ladies who are considering revisionary 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. I have found that the use of words such as “natural” or "D or DD cup” or "make a difference" etc 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.
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). Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select the best breast implant size/profile for the specific patient.
I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps. Best wishes.