What is the placement of implants recommended (above or below) for someone that has a D cup. And what size would be ideal?

I am looking to restore shape, volume and symmetry in my breast after pregnancy. I am currently a 36d on my left breast and a 36b on my right one. what would be the recommended placement? and as for size, i would like to them to be more symmetrical as it is very difficult to find bras that fit properly. I would like them to be slightly bigger and fuller with a nice tear drop shape to them. What size and shape of implants would i need to achieve the results?

Doctor Answers 7

What is the placement of implants recommended (above or below) for someone that has a D cup. And what size would be ideal?

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Thank you for your question. It sounds like you have a significant asymmetry of your breasts. I think that you would be a good candidate for surgery to help correct that and get you the results you want. However, without an in-person exam, or at least a picture, it is hard to give you exact advice on implant choice or placement. 

At this time, many surgeons prefer a sub-muscular placement and there are many advantages to this. The ability to place the implant above the muscle would depend on the thickness of the breast tissue that would be covering the implant, but sometimes that is a good option for patients as well.

I would recommend seeing a local board certified plastic surgeon in your area for a consultation. You can discuss with them your goals and after examining you, they can provide options that would be available to obtain your goals. 

Best of luck!

Implants to improve symmetry

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Hello and thanks for your question
It sounds like you have a noticeable amount of asymmetry between your breasts,so I can understand why you're considering having surgery. It's very hard to comment on specifics without examining you in person and seeing photos, so I suggest that you book a consult with one of the many excellent surgeons in Alberta. 

In my own practice, it's occasionally necessary to incorporate breast lift techniques when dealing with asymmetry cases, so read a bit about breast lifts in case that is suggested to you when you go for your consult.

There are pros and cons to every type of implant. Smooth round implants are more commonly used in North America, but some surgeons prefer shaped textured implants, and get equally nice results. Likewise, there are pros and cons to placing implants below or above the muscle, so it's important to have a detailed consult so your surgeon can help you choose what's right for you. In our practice, we offer implants both above and below the muscle, depending upon each patient's needs and desires.

Best wishes-

Breast Augmentation

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Most surgeons prefer under the muscle for most patients but without an exam or at least good photos it would not be possible to give you any worthwhile advice.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 28 reviews

What is the placement of implants recommended (above or below) for someone that has a D cup. And what size would be ideal?

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Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly 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 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 and be very realistic about your potential cosmetic result.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

What size and shape of implants

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Without a photograph or  an examination it's hard to make any finite recommendations. I can make some general statements only.I find that several things over the last 25 years have helped patients decide which type, shape, and projection ratios will best suit their needs. I think it's helpful if the patient brings in several photographs of what the goal look of her breasts might be. Also, if she can bring some photographs of what she doesn't want this will eliminate trying to express in words what “natural”, “high cleavage”, “low cleavage”, “fake”, and “stripper” may mean to her. I have likewise found the Vectra 3-D imaging platform to be the single most helpful tool in trying to visualize what the outcome might be with different sizes of implants. The Mentor shell sizing system, in which a shell of implant material is placed over the breast and in a padless bra, can likewise be helpful in that it can, not only show the size in a bra, but can give the patient some idea as to what the weight of the implant might be.In my opinion, the implants will look best when the base width of the implant is at, or just slightly less, than a natural base width of her breast. Considerations of chest wall abnormalities, location of breast creases, shapes of the breast, amount of overlying breast tissue, stretch ability of the skin and breast over the implant among other things also play a role in trying to best decide which implant will look best. It can also be helpful if the plastic surgeon, during their consultation, can provide some insight into what the likely outcome would be with different sized implants given their experience in breast implant surgery over many years. We ask our patients to bring different types of clothing such as evening gowns and bathing suits as well as a tight shirt to evaluate what the implant might look like under these type of clothing options. It is also possible to make a home made breast size or using grain rice. Approximately 1 ounce of rice equals 30 mL of breast implants volume. The rice can be placed into a pantyhose leg and enough volume left in the pantyhose such that the rice can be flattened out. You can then tie off the pantyhose and cut off the excess. This flattened rice volume pantyhose can be added on top of the breast inside of a padless bra and can give a rough approximation of what the corresponding implant might look like. Besides the size, most plastic surgical consultations for breast augmentation will also deal with the shape of implants, whether round or anatomically shaped. Here I think the Vectra really shines in that you can place two images next to each other, one with the shaped implant and one with a round implant such that the potential breast implant patient can really see what the difference would look like on them. All things considered, this can be a fun process and the vast majority of patients in my practice are quite happy with their end result. Hope your surgery goes well and good luck.

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

What is the placement of implants recommended (above or below) for someone that has a D cup. And what size would be ideal?

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It sounds as though you have a very significant breast asymmetry.  If one breast is not only larger and also lower on your chest then a combination breast lift on the lower side with implants may be your best option. Generally, if possible implant placement under the muscle is preferred.

Sizing will be based on the base width of your breast which should be examined by a plastic surgeon.  Generally speaking it takes 150-200 cc of breast implants to increase by 1 cup size.  For more information on sizing please read the link below:

What is the placement of implants recommended (above or below) for someone that has a D cup. And what size would be ideal?

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Thank you for the question. 
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. I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.

On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position.

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” or "slightly bigger and fuller" 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. 

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.