Breast implant size for a tall thin woman?

Question

I am 5'10" 123 lbs and I've nursed several children. I have selected a board certified plastic surgeon. I am waffling between 2 sizes: 325 moderate profile and 300 low profile. I am set on a very natural look. I have a very bony upper body and don't want to look fake, which implant do I choose? I'm terrified of looking like an obvious boob job girl, but I want to choose a size that also gives me some fullness where I've lost volume. No breast lift is needed.

Larry S. Nichter, MD, MS, FACS · Answer

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 as I will further explain in the below link.#breastaugmentation#findingtherightsize#BA

Aldo Guerra, MD · Answer

Hello and thanks for your question. There's no way to answer your question and predict your outcome online. I do believe, however, that you're on the right track between 300 and 350. I tend to rely more on high profile breast when patients request upper pole fullness that "looks like a push up bra" while relying on wider implants to enhance the cleavage. A low profile breast implant can create a very natural looking breast. It is always best to try and match the width of the breast implant with your breast width diameter. However, this is how I do sizing and shape in my office and patients find these tips to be reliable:1) Guiding patients to explore reasonable options for breast implant size, usually two to three similar sizes, which allows the patient to visualize how different volumes affect their breast cup. 2) The best guide for a final breast implant size recommendation is derived using measurements from the patient’s own breasts and chest. e more cle3) When measurements are considered then options for sizes can be presented. 4) I use the Mentor Volume Sizing System of breast sizers to demonstrate how these different volumes will look on a patient’s body. 5) This methods offers good reliability and is simple to use, but is not perfect.When patients feel unsure about a size and shape, we ask them back to the office to try sizing until they're very confident with the choice they're making. Best wishes, Dr. ALDO

Joe Gryskiewicz, MD, FACS · Answer

Hi IH,I think you are on the right track.  If you are bony, you probably would want to go under the muscle so you will, as you say, have a very natural look.  The difference in your two choices is less than one ounce, so it probably doesn't matter much.  Either way you will probably wish you were bigger in the distant future.  Most women (90% in our practice) do.  Here are a few tips for you because this is perhaps
the hardest decision for a patient to make, as well as the surgeon. 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.Approximately
50 cc (1-2 oz.) 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 about 25-50 cc, 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. Then, the patient’s verbal requests
are factored into the analysis.Our
average size over the last 7,000 implants was 350. 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 (Flash) Recovery Breast Augmentation articles from peer-reviewed surgery
journals.  All
the best, “Dr. Joe”

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for your question.  In order to determine the right size for you, you should "try on" the implant at the surgeon's office.  I offer different ways of placing the implant, such as transaxillary or inframammary, so there are different possibilities to give you a natural look.All the best,Dr. Results Miami, FL

Steven Wallach, MD · Answer

It is difficult to tell you what size is best for you without seeing you in person.  A thorough exam and review of your goals is essential.

Vincent P. Marin, MD, FACS · Answer

Without any photos, there is no way to reliably pick which implant is right based upon your measurements alone and implant "CCs." Many things such as your skin quality, breast width, skin elasticity, existing breast tissue, chest wall shape and implant size and implant fill all contribute to your ultimate "look" after augmentation. 
No physician can predict what each implant will do on your body until they are "sized in surgery." However, cup size is traditionally very inaccurate measurement scale (you likely wear different cup sizes in different manufacturers now). 
The best way to achieve the look you want after augmentation is first a consultation with a board certified plastic surgeon and adequate communication with your surgeon. This is accomplished through the consult, exam, measurements, anatomic assessment and then in-office sizing. We also encourage patients to bring in photos of the "look" they are trying to achieve. Once all of this has been accomplished, the patient needs to put their trust into their physician to make the "best choice" of likely imperfect options. Then, you will get your "version" of your ideal outcome. 
Best of luck,Vincent Marin, MDSan Diego Plastic Surgeon

Robert Singer, MD · Answer

The best cosmetic result in any
particular breast augmentation patient depends on a variety of factors,
including: your individual anatomy, realistic expectations, a thorough
discussion with the plastic surgeon about the options, and an understanding of
the pros and cons of any particular implant choice. Proper sizing is not just
about the number of cc’s. The thickness of your tissue, breast dimensions which
include the width, height, and projection, as well as chest wall width all need
to be considered when choosing an implant. Trying on implant “sizers” of
various shapes and volumes while wearing a tight t-shirt, bra, or bathing suit
at a preoperative visit will help you and your surgeon choose the optimal
implant.

Keep in mind that following the
advice from a surgeon on this or any other website who proposes to tell you
what to do without examining you, physically feeling the tissue, assessing your
desired outcome, taking a full medical history, and discussing the pros and cons
of each operative procedure would not be in your best interest. I would suggest
that your plastic surgeon be certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) that you trust and are comfortable with. You should discuss your
concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Scott E. Newman, MD, FACS · Answer

It's a little difficult to answer your question without seeing a photo. Also understand that 25cc is such a small amount that it might not be visible.  FYI 30cc= 2 Tablespoons. There is a big difference in the shapes of the implants you mention I. That, although they're both round implants, the lower profile implant is not just flatter but also has a larger diameter. Keep in mind that the 'projection' of the upper pole of the implant/breast will be reduced further by muscle compression. In my experience I find few real indications for low profile implants. I'm happy to advise you further if you'll provide a photo. If you're more comfortable sending the photo privately then it can be sent to scottmd@psurgery.com. Good Luck!!!

Brian Coan, MD, FACS · Answer

Hi Ih, Thanks for your question about which implant size to choose.  It's great that you're excited about your upcoming procedure and that you'll be working with a board certified plastic surgeon.  The difference in size between the 325 moderate profile and 300 low profile is minimal, and without seeing you in person it's impossible to say for certain which would work to give you the most natural result.  You may consider trying one of the new shaped implants as well.  As long as you feel confident with your surgeon and as long as you've shared your aesthetic goals directly with your surgeon then you should rest assured that he or she will have your best interest in mind during your surgery.  My very best to you. -Brian Coan, MD, FACS

Michael Law, MD · Answer

Your plastic surgeon should have given you a range of sizes that will resut in a natural look based on measurements including your current breast size, chest width, etc. He can also give you assurance about your outcome by sharing before and after images of patients with a starting point like yours with an end result that meets your goals. there is much more to a natural result than just the size of the implane, the shape of the implant, the projection, creation of the pocket and placement on the chest wall all are very important factors in a natural looking result.

Breast implant size for a tall thin woman?

Answers (12)