Will 450cc silicone be too large on a 5'6, 155 lbs 'deflated' 38b? (Photo)

Question

I went for a consultation in which 3D imaging was used to 'try out' implant size. I have two concerns. I felt the 450 looked proportioned well to me but the more I read, the more I realize that the size is quite large. Thoughts? My second concern is whether my nipples will inflate and/or lift from their current state with implants only. I've been advised not to have a lift.

Ian Lytle, MD · Answer

Thank you for your question.The size of the implant depends on several different factors. How small or how large your breasts already are. How large you want your breasts to be. Your general height and weight, how wide your chest is and how loose or tight your breast skin is.You are right, in gereral a 450 CC implant is a large implant and 350 cc's is more of an average sized implant. But given your height and weight and self-described "deflated b cup" breasts, this may be a very reasonable choice.The nipples themselves should not change size or shape,  but the areola may spread out a little, especially if they are already stretched and loose. I do believe with this size implant (even a 350), that your nipple and areola complex will rise up. By looking at your 3D images, I would be surprised if you would need a lift.If you haven't already, make sure that you also use a sizing system that places the sizers on your chest while wearing a tight shirt so that you can see what that volume looks like on your body.Good luck

Joe Gryskiewicz, MD, FACS · Answer

Hi Tata,I agree from you photos that you do not need a lift.  I would consider a dual plane however.   I also attached an article from a peer-reviewed journal to give you an eve better idea.Here are a few tips for you because picking your size is perhaps
the hardest decision for a patient to make, as well as the surgeon.  Also see the video attached to my answer.  We spend up to two hours for our BA consults
to be sure there is careful communication. We do a full exam in front of a
full-length mirror taking six exact measurements.  We put your photos on a large computer screen
for imaging, and go over your “ideal-size” photos. We then save this
information to your password protected “web account.”

First and
foremost the implant should fit the dimensions of your breast and tissue cover.
 Balancing the implant to your
over-all body shape and tissue cover is essential.The main thing is to have the diameter of the implant fit the diameter of
your breast "foot print".  The average size
chosen over our last 7,000 breast implants was “350cc”.  BUT, 90% of our patients tell us they wish they were bigger a year after
BA.  (We will see you every year for
routine checks at no charge.) It’s like your mind incorporates the "new
you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients
that they will experience an increase of approximately one cup size per 200 cc.
 You can try on implants in the office by
placing them into a special bra.  The implant is also flattened somewhat when under
the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for
flattening of the implant in the partial sub-muscular pocket.  Once you decide on a size you like, then add
on 25cc, because in real life the implant will be flattened slightly by your
tissues.  Multiple measurements need to
be taken to fit an implant to your exact anatomy.  Have your surgeon's office
show you the charts of the implant dimensions for the various profiles of
silicone and saline from the manufacturer.  Then you and your surgeon can
piece together the puzzle by matching your measurements, with your wishes,
versus your tissue cover and the available implants to arrive at
a surgical plan.  Keep in mind
larger implants tend to have more problems over the years.  Since silicone implants wrinkle less than saline
implants, they might be your best bet.

You can
also approximate this at home by measuring out an equivalent amount of rice
placed into a cutoff foot of old panty-hose, and put this in your bra.  Wear this around the house for a while, and
see what you think.  Implant size must
square with assessments of tissue cover, breast diameter, and chest wall width.
 Multiple measurements of your chest wall
are taken (seven in total).  Implant size
selection has been an issue of much discussion.

Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.  Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape.  A photo album of patient
pictures is maintained to assist them.  These photos ultimately help in determining
where the implants will be placed, since they can be shifted inside (to provide
more cleavage), to the outside, up or superiorly, and down or inferiorly during
surgery.  In determining the final size
selection, I always place the highest priority on the preoperative measurements
and potential tissue cover.  Finally,
your verbal requests are factored into the analysis.

We use
the quick-recovery approach, so click on the web reference link below to have
this explained and you can see the list of Quick-Recovery (Flash-Recovery or
Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery
journals.  It is a surgical procedure that
uses special instruments and techniques to minimize tissue damage and avoid
touching the ribs. It causes far less trauma to surrounding tissue than traditional
approaches, and it dramatically reduces pain and recovery time. In published
studies of BA patients, 95-percent of women interviewed after the procedure
returned to normal daily activities within 24-hours. Quick-recovery BA is not a
“gimmick.”  These specialized techniques,
which actually speed recovery and get you back to your daily routine, kids and
work, are published in our plastic surgery journals.  Because these PS journals are “peer-reviewed”
and edited, they are the gold-standard in our field as being valid science.
Therefore, these are sound techniques, not marketing hype.

Be sure
to see only a board certified plastic surgeon (by ABPS - The American Board of
Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic
Plastic Surgery) and or a member of ASPS (The American Society of Plastic
Surgeons).  Also, ask if the PS has an
established, high volume breast augmentation practice, performing several
hundred breast augmentations each year.  Be sure the PS has been in practice for a
while, about 20-years might be a good gauge. 
Does the PS offer all three incisions? 
Discuss the implant type (gel or saline), shaped "gummy bear"
or non-shaped, smooth or textured, implant pocket (over or under the muscle)
and the "quick-recovery approach." 
Ask to see their before and after photos if you didn’t see any on their
website.  If they are experienced, they should have several 100 breast
implant patients for you to view.  I would also recommend that your doctor
offer you the chance to talk to past patients who would be happy to discuss
their experience with you.  You need to feel comfortable, so make sure the
environment is safe as in an accredited surgery center.  Also, ask a prospective surgeon if he or she
has ever published journal articles in professional peer-reviewed journals,
which they can provide you.

All the best, “Dr. Joe”

Jaime S. Schwartz, MD, FACS · Answer

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!

Dr. Schwartz

Board
Certified Plastic Surgeon

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon

Nana N. Mizuguchi, MD, FACS · Answer

You will most likely need the volume to help you restore not only the volume but your shape for your breast augmentation.  Make sure that the implant has the proper width to improve cleavage and fill the upper pole.  I like using the Inpspira or Sientra 107 type breast implants.Best Wishes,Nana Mizuguchi, MD

Pramit Malhotra, MD · Answer

You could also consider shaped "gummy bear" implants.  This will lift the bottom portion of your breast that has fallen more and give a slightly more tapered or tear drop look to your breast which will fit your shoulders nicely.

Lawrence Scott Ennis, MD, FACS · Answer

The best way to pick implant size is based on your breast and chest width and not the volume. As the implants get bigger, they get wider. When the width of the implant fits the width of your chest, it will look nice and fit your frame. If the implants are too small, you will have a gap between them and they may look too far apart. If they are too wide, they will make you look top heavy as they may be too wide and stick well out past the sides of your chest. There are ways to get a bigger or smaller look.This can be done by picking a different implant profile. The higher the profile, the narrower the base width of the implant. If someone has a very narrow chest and wants to be big, they should consider a higher profile implant. If someone has a broad chest and they do not want to be too big but want to avoid the gap and still have cleavage without projection, they should consider a lower profile implant such as a moderate. There are options in between these such as the moderate plus.  I prefer the underarm approach so there is no scar on your breast. The new silicone is the only way to go as far a rippling as teh new silicone ripples much less than saline, especially in the larger implants. Dr Ennis

Kenneth R. Francis, MD, FACS · Answer

Dear Tatatada,You have obviously already been imaged with 450cc breast implants.  Even though the after image is not a strict guarantee of your results, it is a pretty good approximation and does not appear disproportionate.  Good luck!

Carlos Burnett, MD, FACS · Answer

You nipples will not lift with the placement of breast implants. Your areola will stretch and appear wider. A 450 cc implant can be sizable if placed in a small framed woman. At 5'6" this choice may be quite aesthetic depending upon your goals. Discuss your implant size selection with your surgeon.

Tom J. Pousti, MD · Answer

Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery.   Although your plastic surgeon will be able to provide you with more specific predictions, I think that breast augmentation surgery should "inflate" the nipple/areola complexes nicely.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, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Generally speaking, the best online advice I can give to ladies who are considering 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. For example, I have found that the use of words such as “natural” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
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. I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Brooke R. Seckel, MD, FACS (retired) · Answer

450cc is a large implant. Best to base implant size on your breast base width which your surgeon should have measured. Seek a consult in which breast implant sizers (by Mentor) can be placed into a bra so you can 'feel the size. For more on sizing read below:

Will 450cc silicone be too large on a 5'6, 155 lbs 'deflated' 38b? (Photo)

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