I am having a Breast Augmentation done on Feb 12, 2016 and kind second guessing myself. Any suggestion? (photos)

I am having my BA done next week. I have my Pre-op on Wednesday and at my last appointment we talked about 425 cc, round gel implants, under the muscle. I had Gastric By pass 3.5 years ago and lost over 120 pounds so just wanting to add volume back to my breast. Right now I measure at 34.5 inches around and 36 inches around the fullest part, bottom part of breast. I dont want to be large just filled out more. I went from a 42 ddd to a 34 b/36 a/b depending on the brand.

Doctor Answers 21

Implant choice

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The implants which fit you will depend on your breast measurements and tissue. The base width diameter of the implant must match your breast and this will be a factor in the overall volume.

For patients in your situation who don't want to increase size much but do want perkier breasts, typically a breast lift procedure will provide better results. It may be possible to place a low/moderate implant with a subtle volume increase, however this will likely do nothing to lift the breasts. Depending on placement, the implant could weigh the breast down and cause more sagging or sit in place with the excess skin dropping off the bottom of it. Careful In-person examination would help determine the best choice for you.

It is important that you understand the limitations of each procedure and that you know what you can expect from your implants.

I recommend that you share your concerns and consider all options when you meet for your pre op appointment.

All the best

Breast Augmentation

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Thank you for your important question. There are several options to help you with your decision:

  • The Rice Test- This involves placing measured amounts of Rice into a plastic bag and inserting it into your bra-you can do this at home and this test gives you the most accurate idea of how you will look with varying amount of Breast Implant volume-see link at end of article on how to do this test
  • Look before and after pictures
  • Try different sizes Breast Implants in your bra at your doctors office-this is the least reliable method
  • Talk to friends who have had the operation and ask them to share their experience....Good luck :)

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 437 reviews

Aug after weight loss

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It is important to have implants that are the proper diameter (base width) to fill out your breasts well. If the base width of your selected implants matches your breasts, you are likely to achieve your goal of increased fullness. The question in my mind is shape. You appear to have some sagging. Implants alone will not fix sagging. If you want improved perkiness, be sure to discuss this with your surgeon. Good luck with your procedure!

Implant size

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Choosing the right size implant requires an in person exam. However, based on your photos and your desired outcome, it looks to me as if you would need a breast lift with an implant to achieve those results. If you aren't wanting a lift either because of the cost or the scaring just make sure that you are realistic about the results that you can achieve with an implant alone. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Breast Augmentation

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Hi & thank you for your question.
The pre op appointment is a good time to discuss your concerns. Make sure you talk with your surgeon about your goals and expectations. Best of luck.

Implant size

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Breast implant selection is best done in the setting of a formal consultation with a board certified plastic surgeon.
Choose your surgeon carefully; this is the most important decision you will make in regards to your breast augmentation. All members of the American Society for Aesthetic Plastic Surgery are board certified in plastic surgery with experience in cosmetic surgery. surgery.org will give you a list of such surgeons in your area.
Come to your consultation prepared to discuss your aesthetic goals - bust fullness, figure balance and breast shape. Bringing photos to illustrate your point can be helpful. After an examination your surgeon will be able to discuss and recommend particular implants that will best achieve your aesthetic goals. Some surgeons will use various tools to help patients choose their implants. Implant sizing, 2D photography, 3D photography and photo gallery review are a few. Ultimately I believe the patient should make the final decision with regards to the implant. I believe the surgeon's role is to offer advice; I do not think the surgeon's role is to dictate which implants patients choose. Having said that, if you have chosen a surgeon with a great deal of experience and success, take advantage of their perspective.

Michael B. Tantillo, MD
Boston Plastic Surgeon

Lift and augmentation

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It looks like you might need both an augmentation and a lift to accomplish your goals. What size is right for you, is difficult to say without an exam.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Implant sizes

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With your history of weight loss, it's not uncommon that plastic surgeon would recommend a lift with smaller implant rather than trying to fill the space with a larger implant. I have found that when the patient has a little bit of droopiness after weight loss ,a large implant will drag down the breast quite quickly. I have found the Vectra 3-D imaging to be very accurate in depicting the different breast implant sizes and shapes and what you would look like with each individual implant on a three-dimensional photo of you. Hope this is helpful. Good luck on your impending surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 56 reviews

Dr Kayser

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Thank you for your question. Congratulations on your decision. From your photos, however, you do appear to have a moderate degree of breast drooping or ptosis. Also, based on your history of weight loss, it is likely that your breasts have significantly reduced in size from a much larger stretched out skin envelope when you were heavier. This can raise concerns regarding the elasticity and long-term results if breast implants alone are placed. An implant will necessarily increase cup size, however, in the long term setting, descent of the implant into the breast pocket will likely result in a breast that is still droopy. Although scars are obviously something that patients do not want to have, a breast lift will help to restore the position of your breast on the chest wall.

another option, should you desire not to have a breast lift, would be the use of fat grafts. Fat transfer is the concept of harvesting fat from one area of your body to be transferred into the breast. Unlike implants which require a specific pocket, fat is harvested and introduced as millions of minute seeds which are dispersed throughout the entire soft tissue envelope. Because of this, fat can be placed wherever the surgeon desires. This cannot only improve breast volume, but can also help to restore upper pole volume loss in ways that an implant simply cannot do. In any case, I would recommend a consultation with a board certified plastic surgeon who is experienced in all these techniques. I hope this helps and have a wonderful day. Dr Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
5.0 out of 5 stars 43 reviews

Breast Lift with Implants

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Since you have some ptosis after the weight loss, I would recommend placing textured round moderate or high projection silicone implants over the muscle to maximize the lift you get from the implants. Going under the muscle will require larger implants and not achieve the same amount of lift as over the muscle. You appear to have ample breast tissue to handle the implants under just breast tissue. Good luck.

Robert M. Tornambe, MD
New York Plastic Surgeon
5.0 out of 5 stars 33 reviews

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.