Go Against PS Recommendation For Breast Implants? (photo)

I am 5'3" and 128lbs, I wear a 34A in VS and have a short torso. My PS gave me his prof opinion on "perfect size for my frame". He suggested 304 silicone mods. He said a 339 mod or 350-375 HP would still fit my chest measurements, but would be pushing it. After reviewing pictures, I can't help but want to go 375 HP. I would rather have a little fakey and perky vs big and saggy. He is also doing a lift, just around the nipple. Will I look ridiculous with 375 HP?"

Doctor Answers 19

Implant Selection Process

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In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Sizing for BAM

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There are several variables in determining implant size.  When recommending implant size for my patients, I consider the followings: 1) patients' anatomy (height, weight, chest width, chest height, amount of breast tissue) and 2) patients' desired look/goal.  Without knowing your chest measurement and breast tissue amount, I cannot give you any recommendation.  You should visit with board-certified plastic surgeon who will examine you.  Try implant sizers to get a rough estimate of the size you may want.  As you know, bra/cup size will vary depending on the brand.  Good luck with you.
Dr. Sugene Kim

Avoid large implants by simultaneous lift

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300 cc implants would take you to size D.  However, just as important as implant size is a lift.  You may benefit from a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue to increase upper pole fullness, raise your breast higher on the chest wall and more medial to increase cleavage.  An implant can be placed at the same time.  Aligning the areola, breast tissue and implant high on the chest wall over the bony prominence produces the maximum anterior projection with a minimal size implant.  Smaller implants are more stable long term and have less complications.  375 cc implants may be too large for you and may not fit retro-pectoral.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

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Going against operating surgeon recommendations

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I am concerned with the question and the 15 responses I see here. With many years of experience and thousands of cases, I can say that this size, shape, and type of breast is a setup for a poor outcome if the surgeon doesn't know how to fit and position the implant, adjust the inframammary crease level, or the patient is choosing the implant volume or expect size/shape of the breast. 

In rhinoplasty, this is part of the Michael Jackson problem. The patient thinks they can just choose a nasal size/shape/type and the plastic surgeon will give it to them. If one plastic surgeon tells them that can't be done then they will find one who will do it or talk an inexperience surgeon into it. 

Small breasts in a thin patient with a constricted lower pole (pseudoptosis) need a diameter of implant (and the same height in round) that exactly matches the interior width of their breast and no larger. The inframammary crease has to be lowered so that the distance from the nipple to the crease (under stretch) is the same as the distance from the nipple to the medial edge of the breast (not under stretch). The new inframammary crease level has to be controlled and healed properly. A periareolar lift to move the nipple-areola (not the breast) is not needed as implants do not lift breasts but the filling out of the lower pole will simulate it. A silicone gel-filled implant should be considered because there is very thin coverage over the implant in the lower pole of the breast. This is best done short term and long term through an inframammary crease incision. 

The volume of the implant is determined by the diameter of the implant that will fit the interior width of the breast and the forward profile chosen by the patient (lowest to highest profile or 1 to 2 cup size increase) and the tissues will accommodate the forward volume. The number of cc's is found by looking on the implant charts. External sizers are not helpful for this determination and are misleading. Sizers during the surgery are not needed. 

It would be nice if plastic surgeons could just make whatever implant the patient chooses work or turn the patient's breast into whatever she wants but an implant is just a pillow and if it's going to fit and look right without problems and distortions, it has to be sized and positioned properly and then healed there. The result will look like the patient's breast filled out by about 1-2 cup sizes. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

The right implant for you

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Hello. The size your surgeon recommended seems reasonable to me but if you want more and the 375 HP fits your measurements then talk to your surgeon about your concerns. What he describes as “perfect for your frame” may mean what would look the most natural for your body. If you are going for a more “fakey and perky” look make sure your surgeon knows how you feel. Maybe bringing in pictures of how you’d hope to look could ease some of the confusion.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews

Go Against PS Recommendation For Breast Implants?

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You might need to chose a new PS but I think you should have a large % of the input choice to your implants. 

Correct implants for Sagging breasts

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You have breasts that are saggy with your nipple almost at the inframammary fold.  However your nipples are still fairly close to the mid-arm level which is where you want them to be.  The larger the implant you chose the more the implant will need to be placed in a lower position in order to center the nipple relative to the breast so the nipple does not look low relative to the breast.  The larger you go the greater the need to lower your current inframmary fold if you do not do a breast lift.  This means the inframmary fold crease needs to be released from inside so that it can stretch and efface over time.  If the surgeon is not familiar with how to release the fold then you will have a double bubble deformity after surgery.  If the inframmary fold is released then the double bubble will gradually efface depending on how big you go.   Usually this takes up to 6 weeks to efface.  If you chose a high profile implant instead of the Allergan smooth moderate profile of 304 cc which your PS has suggested then the diameter of the implant will not be as wide and thus the fold will not be lowered as much.  The HP profile implants are not as wide.  A smaller diameter implant will tend to develop its shape quicker since the inframmary fold will not need to be lowered as much but you may not have as much cleavage because of the narrower implant.  I hope that helps.  Dr. Chu

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 106 reviews

Larger than implants than plastic surgeon recommends

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Choosing implants for a breast augmentation is a difficult task.  Implant size is based on your aesthetic goals and your anatomy.  Additionally, sometimes going with implants that are too large may have more long-term complications and issues requiring more surgeries -- capsular contracture, implant malposition, etc.  Keeping these issues in mind, I would discuss your desires and aesthetic goals with your plastic surgeon; also, ask him or her his concerns regarding going with a larger implant.  If you want the perky and high look, the 375 cc HP are probably ok, but you definitely need to discuss these concerns -- it is important that you feel comfortable with your decision to have surgery.  Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 21 reviews

Breast implants

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375 is not too big, and would look good. You may even consider implants only, and only raise the nipple after the skin has stretched. You may not need it.

Good luck.

What is the best implant for my size - high profile or moderate profile

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One of my favorite quotes from a famous breast plastic surgeon: "Everyone wants natural, but natural is getting bigger every year".

I find this to be true. Almost every patient desires slightly larger breasts after they have adjusted to their new frame.  It is true that the larger you go, the more implant related changes can occur.  However, the average in my office runs around 350-425.  I have also seen a shift to high profile implants - partly because the patients are requesting larger implants but also because most patient's like the appearance of the "perkier" high profile implants.  

Based on most patient's desires, I would say go with the slightly larger implants.  Statistically, you will probably want them even larger after a few months!

Good luck!

(Keep in mind that this should not be construed as medical advice, simply a conversation on the topic) 

Brian Dorner, MD
Columbus Plastic Surgeon

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.