What size implant would be best? Having a difficult time deciding. (Photo)

I am having a lift and augmentation. I am a runner and don't want my implants slowing me down. I have had two children, breastfed them both and was a 34D prepregnancy. Lost all my weight and some and would just like to be back to my prepregnancy size. Thanks!

Doctor Answers 12

What size implants

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From the look of your photographs, I would recommend a mastopexy and breast augmentation at the same time. From your description of how much stretching the breasts have undergone ,it's been my philosophy that taking more of the skin out and placing a smaller implant will lead to a more durable effect of the lift. The size of the implant can best be measured by what the maximum width of your natural breast is. I would think somewhere around 200 mL with a vertical lift would be my operation of choice. Try to find a plastic surgeon with experience in mastopexy augmentation. Good luck.

Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

Breast lift with implants

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Hello and thanks for reaching out to us. Without an examination, it is hard to tell you exactly what would be of most benefit to you. The short answer to your question is to go to a board certified plastic surgeon with expertise in aesthetic breast surgery who is not afraid to do a lift and augmentation at the same time. I have found that some surgeons are not comfortable with lifting techniques and do not perform an aggressive enough lift and this leads to continued sagging (even though some patients can get recurrent sagging due to gravity/genetics/tissue quality).

With respect to implant size, you will need your base width measured and then from there can decide what implant volumes and projections would best satisfy your goals and expectations. A breast implant is like a ball, and a ball has a certain diameter.  Your chest also has a certain width on each side between your sternum and where each side of your chest ends near the axilla. It is important to pick an implant that has a base width that is not greater than this width to be able to satisfy your goals and expectations.

When I discuss with my patients about breast lifting techniques and also use of implants, I break down the different topics into parts.

The easy way to decipher what each procedure produces is that implants increase breast volume and add upper pole fullness. Implants are placed in either a subglandular or subpectoral pocket centered over the left and right chest breast footprint. In your case, you appear to have thin skin and I would recommend a subpectoral or dual plane position.  In patients like yourself with sagging who undergo an augmentation without a lift, their breast tissue hangs off of the implant that is sitting on their chest, creating a shape like Snoopy's nose, hence called a "snoopy" deformity. Implants can not give a therapeutic lift and taking shortcuts will only lead to suboptimal results. In some borderline cases of ptosis, breast augmentation can be performed and if there is unsatisfactory sagging, then a lift can be performed later at a second stage, but in your case, an in person examination with a board certified plastic surgeon will be most instrumental in going over your lifting options in conjunction with implants.

Two lifting techniques that are very good ones in the right patient and I use are based on the following:
1) if it is mainly the nipple position that needs lifting, I like the circumareolar approach (also called a donut lift)
2) if a large portion of the breast tissue/weight needs to be lifted, a circumvertical (also called a lollipop lift) and sometimes a full anchor incision is needed as the circumareolar approach in my mind is not strong enough to hold the weight of the breast and results in stretching of the areola and drooping over time.

Click on the link referenced below and scroll down and the two examples listed are of patients whom had both mastopexy and augmentation and you can see one patient in whom the circumareolar approach was sufficient whereas the other needed the circumvertical incision. I hope this helps you!

Dr. Sean Kelishadi

Sean Kelishadi, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 32 reviews

What size implant would be best? Having a difficult time deciding.

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Hello dear, thanks for your question and provided information as well.. The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift with augmentation such as silicone implants, you will get very nice results, contact a board certified plastic surgeon, I recommend you soft cohesive silicone implants about 350 cc's you will look pretty and they will be perky, hugs!

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 442 reviews

What size implant would be best? Having a difficult time deciding.

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If you're having a mastopexy and an augmentation at the same time - I would not recommend going higher than 325cc, as going with more volume can compromise the quality of a lift. 

Deciding on Breast Implant Size

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Your Plastic Surgeon will measure you to determine the best shape and size of the #implants to be used. In my practice, about 20% of the patients benefit from #shaped implants.
It's important to know what size bra you currently wear. Is it a 32, 34, 36 bra, and, of course, the cup size? The strap size is important to know because that affects the diameter of the cup and subsequently the diameter of the #breast implant that we choose. It is also very helpful to know your height, your weight, and your dress size as well. These are among the aspects which should be considered when discussing your #implant #options.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Choosing best breast implants for your situation

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Hi and thanks for posting your questions, photos and concerns on RealSelf!

You would definitely benefit from a breast lift with augmentation to achieve better breast aesthetics. I would counsel you to choose a modest size and profile implant given your avid running history. I believe that having a candid conversation with a reputable Board Certified Plastic Surgeon in your area will help you best achieve your goals.

Many surgeons are now employing the use of computer modelling to help educate their patients about choosing the best implants for their anatomy and activity levels. 

I certainly wish you the very best in achieving your goals!

Rachel Streu, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Breast Augmentation: information

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RealSelf 1 Aug choices. Dear Ms. Fsalast1313,

Thank you for your story, question and photos. I agree you will need a breast lift and augmentation to achieve a more Aesthestic appearing breasts.

Breast appearance, size, filler material , shape and implant location is a personal choice guided by the experience of your Plastic Surgeon. Your SPECFIC breast anatomy will
dictate some of your choices.

As far as size you know all bras are not equal in "cup size" measurements.
"Cup size"is a very crude and non standardized measurement and varies by bra manufacturers. Thus actual cup size you eventually are measured at is not as important as your body proportions as it relates to your desired breast size

My specific responses are:
A)Realizing there are no standard bra (strap/cup) sizes, purchase several bras (full bodied and no padding) of the strap and cup size you think you want to be.
B)take a measuring cup (1 oz=30cc) place rice in a nylon. Therefore 10 oz. = 300cc...
C) try on various volumes of rice with some form fitting clothes.
D)if implant is placed under the pectoralis muscle I usually add 10% volume to what the patient chooses.... To compensate for the muscle pressing down on the muscle and for
the naturally settleing of the implant which often makes the breast appear smaller 2-3 months after surgery.

2) profile of implant:
A) for the same volume the higher the profile the narrower the base width.
B)there is very little difference in projection between a moderate to high profile implant
thus little affect on how the actual nipple will look.
C) the base width of the breast should equal the base width of the implant
D)thus I personally chose the profile based on the patients chest measurements,
(a high profile on a wide chest may not result in the cleavage desired and
conversely a low profile on a narrow chest may result in implant in the outside arm
E)Cleavage is largely determined by your anatomy. This can be optimized by choosing the best profile implant and postoperative implant displacement excercises towards the midline of your chest.

3)Shape of the implant:
A) for the vast majority of cosmetic patients I recommend round implants
B) reconstructive patients shaped/form stable implants are often used

4)Placement decision of implant(subpectoral, dual plane, or suprapectoral) will be determined based on your anatomy and long term goals and benefits.

5)Filler Material
A) silicone gel feels more like breast tissue, less potential rippling, comes prefilled cannot adjust size intraoperatively and larger incisions to place compared to equal sized (non prefilled) normal saline implants.
B) normal saline implants can be adjusted in size intraoperatively, if ruptures normal saline absorbs, potential increase rippling compared to silicone gel, smaller incision to place normal saline implants as compared to prefilled silicone gel implants.

I suggest you collect several nude model photos of the goal breast shape you desire and schedule several consultative appointments with Plastic Surgeons who are experienced and is Certified by the American Board of Plastic Surgery and ideally members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

My best wishes,

R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Need an exam to determine best breast size

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Thank you for your question and photographs. I agree with the need for a lift and not going too large for someone who is as thin as you are and the fact that you are a runner. It is hard to give you a good size estimate without an exam; so, take any recommendations off of the internet with a grain of salt.  Be sure to see an experienced, board certified plastic surgeon. 

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 40 reviews

What size implant would be best? Having a difficult time deciding.

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In combination this full lift I could maybe recommend only a 400 cc implant. But best to determine with your surgeon...

What size implant would be best? Having a difficult time deciding.

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Thank you for your question.  Although the size is really up to you and the look you are going for, it is often recommended that the implant size be more on the conservative side (approx 350 cc or less) when combining an augmentation with a mastopexy so as to limit the potential for problems with wound healing and poor scars. Discuss these issues with your plastic surgeon before proceeding.  Best wishes!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.