34B, would like to be 34D. Would saline 500cc moderate plus profile be a good choice for me? 5'7" 140 lbs. (Photo)

Hello,With all do respect, you have it all wrong. You are not the one to decide what implant is going to yield what result/bra size/cleavage/etc. Further: 1. No surgeon can guarantee a cup size, so it's a bad way to think about or convey your aesthetic goal size; in-office sizing is a much better way.  2. High profile implants are the worst choice for pectus carinatum, as they are more likely to drift into your armpits. 3. In general, high profile implants carry the highest risk for all complications and re-operations. 4. Cleavage is not controlled by implant profile or size, but instead by the dimensions of the pocket the surgeon makes, which is limited by your anatomy. 5. Capsular contracture is not higher in silicone gel implants.  It is a phenomenon of bacterial contamination, and the risk of cc is directly proportional to the surgeons desire to adhere to the 14 point plan to protect breast implants from bacteria. 6. Your anatomy dictates the maximum sized implant that should be considered, not  your aesthetic goal. Go visit a few ABPS certified/ASAPS member surgeons who are expert in all aspects of cosmetic breast surgery. Best of luck!

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  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.  This entire surgery
can be performed with a small incision technique.  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

Dear misskrissy,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

I recommend seeing a plastic surgeons to discuss the different options for breast augmentation.  Bra cup sizing is not an accurate way to choose a size because all D cups are not the same.  Also, everyone has a different definition of what "natural" is.  There are different ways to choose a size.  I like to look at patient's "wish" photos. 

Many factors weigh into your final size and appearance. Your fold diameter, rib cage anatomy, and type and amount of breast tissue will be factored. Seek consultations with Board certified plastic surgeons in your area. 

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 questions, the difference between rates of capsular contracture in silicone vs. saline implants (when placed submuscular) is negligible. Implants will not create cleavage regardless of the profile. Widely spaced breasts will never have cleavage irrespective of implants. That being said, patients with natural cleavage can expect higher profile implants to enhance this appearance. In the case of pectus, appropriate sizing based on BWD is more important than profile. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

You should get a good result with either saline or silicone.  I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I do this with my patients, 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 breast implant is right for them.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Thank you for your photos and question.  I think you will have a great result but the 500 cc might be a little too big for you. The accurate profile really depends on your measurements and your desired look you wish to achieve.  I would recommend seeking in person consultations with board certified plastic surgeons in your area for more. Best of luck to you 

Sizing of implants is a complicated process and requires detailed communication between surgeon and patient. We use a multi-step process to take guesswork out:1. You bring in wish photos2. You are examined in the office, with measurements and a 3D scan taken3. We simulate different target implant size/styles in the software on your body model and get your feedback4. Having narrowed down the selections, you try on sizing kit sizers with a snug bra/top to see what kind of projection you likeThis usually allows us to home in on 1-2 size choices and empowers the patient to feel like a decider in the process. Revision for size dissatisfaction is very rare in our practice with this methodology.Saline vs. Silicone: in general, most surgeons prefer silicone due to the softer, more natural feel. There are now many gradations of choice of silicone based on level of cohesiveness of the gel, which adds options for the patient and surgeon. Saline implants feel firmer, and tend to ripple more in thinner patients. Capsular contracture risk is a multifactorial and complex issue probably more related to biofilm/microbial exposure to the implant during placement than it is to saline vs. silicone selection. High profile vs. moderate plus profile is a decision I make based on chest wall dimensions and other factors; a higher profile implant will be narrower and stick out more, which may or may not be the right choice in the presence of a chest wall deformity like pectus carinatum; exam in the office helps identify these issues.

Thanks for reaching out and sharing photos! You seem to be a great candidate and will receive a stellar result! As for the sizing, you seem to be in the right range for the size you want, but it is always best determined with an exam and measurements. I would start by going on a few in person consultations with experienced board certified surgeons, you can do sizing while at your consultation and decide on what amount of cc's will get you the size you want and will love! Best of luck! Dr. Kachenmeister