Will 490cc implants make a good difference in size from 385cc?

Dear Ms. Practical 894810,

Thank you for your questions. Unfortunately without measurements, evaluation of your skin elasticity and a exam of your tissues I can can only comment based your story and photos. However, I hope you find my following comments helpful.

There are many variables besides just implant volume. Here are some of the additional decisions that you and your Plastic Surgeon will need to make together:

I. Size/volume of implant.
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) most women are NOT perfectly symmetrical either in volume, shape and nipple/areolar position. Usually differential sized implants can be used if there is a significant breast volume discrepancy (usually greater than 50-75 cc difference in volumes). Intra operative maneuvers can be used to improve nipple areolar and breast symmetry. If needed after the breasts have “seated” (final position) and if desired the nipple/areolar position can be adjusted under local anesthesia as a minor surgery in the office.

II. Profile of the implant
A) for the same volume the higher the profile the narrower the base width.
B)there is very little difference in the ultimate and final nipple projection or breast projection between profiles.
C) In my opinion the base width of the breast should equal the base width of the implant to eventually obtain maximum cleavage and prevent lateral (increased side) breast volume. 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 area).
D)There are 3 companies that Most plastic surgeons have access to all companies. Allergan has the most profile choices.
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.

III. Shape of the implant:
A)for the vast majority of cosmetic patients I recommend what are referred to as “round” implants
B) for reconstructive patients shaped/form stable implants are often used because of acquired lack of breast tissue.

IV. Placement of Implant
A)decision of implant(subpectoral, dual plane, or suprapectoral) will be determined based on your anatomy and long term goals and benefits. Placement under the muscle and dual plane are associated with the lower chances of capsular contracture.
B) Location of the implant on the chest wall will depending on your specific goals ie upper pole fullness (high and “fakery”), neutral (full slope) or lower pole fullness.

Filler Material
A)Siilcone gel “gummy bear” filled implants feel most comparable to normal breast tissue, tend wrinkle less and are less palpable.

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 hope you found the above helpful. Nothing substitutes for a person evaluation and discussion of your specific options.

I suggest you collect several nude model photos of the goal breast shape you desire and schedule several additional consultative appointments with experienced Plastic Surgeons or if you have chosen a Plastic Surgeon please make sure he/she is Certified by the American Board of Plastic Surgery and ideally a member 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



Robert Hardesty MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
Awardee RealSelf Top 100 & inductee in RealSelf Hall of Fame
wwwimagineplasticsurgery.com
4646 Brockton Ave
Riverside, Ca 92506
(951) 696-7600

In general, 200 cc may increase you one cup size. However, there are a range of factors that will affect implant size. Women of greater stature may require more than 200cc to augment their breasts from a B to C cup. Women who are more petite, or who have very narrow frames, may require less than 200cc to gain an increase of one cup size.

The difference is approximately 100 cc.  If you are size 32 or 34, each 100 cc corresponds to 1 cup size change.  If you are size 36 or 38, each 100 cc corresponds to ½ cup size change.  However, I am more concerned about the fact that you have capsular contracture.  This raises several questions: will the capsular contracture be resected or will you have the pocket switched to a different location?  Most people prefer to change implant location when a capsular contracture occurs, which means placing a pre-pectoral implant rather than retro-pectoral.  Pre-pectoral implants often look bigger and you may be able to get by with a smaller implant and still look better.Best Wishes,Gary Horndeski, M.D.