I'm 5'4", 142lbs and aiming for a full C cup. Should I choose 405cc or 450cc?

Question

I am 5'4". Broad shoulder. Wide rib cage. 142lbs. Aiming for a FULL C cup. Right now I'm a 36A. My final consult was today & I chose 405cc. Since coming home & thinking over I think I want 450 to achieve what I want. With my frame should I stay at 405 or go higher in cc?

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look. 
I would not struggle over 45 cc as this will make a very subtle difference in final outcome (approximately equivalent to a shot glass). The best advice is to love the look not the cup.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Shlomo Widder, MD · Answer

Dear Ree,         Front and side view pictures of your breasts would have been very helpful. If indeed you are currently 36 A cup size, to become 36 full C cup size, you will need implants with volume of 450 cc.  However, I have been in practice for over 30 years and performed breasts augmentation on thousands of patients. I have noticed that women tend to over estimate their breasts' size, mainly, because bra manufacturers like Victoria secrets make the cup size small , to let  women feel better about their breasts size.    So, if on measurement (by your surgeon) you are in reality 36 small A cup size, you will need implants with volume of 525 cc to become 36 full C.   You have to realize that not all results are the same, because experience, technical skills and aesthetic eye are critical for good outcome. So, do your due diligence carefully and choose your surgeon wisely.    Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                Best of luck,                                   Dr Widder

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Ram Kalus, MD, FACS · Answer

Unfortunately, words alone cannot allow us to arrive at any conclusions or suggestions. Without a physical examination or at the very least, photographs, it is difficult to respond with any specificity or accuracy, but the best way to determine which breast implant size is best for you is by first finding out your specific wishes not only with words or letters as in cup size or “not too big” or “natural”, but also with a VISUAL understanding of what you hope to look like. This can be accomplished either with photographs of patients whose breasts and body type look like you, or ideally with photos of patients not only whose breasts and body type visually are similar to yours, but are also a similar height, weight, and pre-operative breast size. In our own practice we have that unique functionality on our website.
Unfortunately the most common reason for a woman to be unhappy after her augmentation is feeling as though she is either too big or not big enough. I do not place the onus of selecting the breast implant size on my patients since they are coming to me for my advice and expertise, but I do ask my patients to be as specific as possible about their aesthetic goals and I then advise them accordingly. The final decision as to which implant will be used in surgery is made in the operating room after inserting "sizers" that show us exactly what you would look like with a 405 versus a 450.
I would advise you to discuss your concerns once again with your plastic surgeon, use photographs to communicate your desired end point, and make sure that your own sense of aesthetics aligns with that of your plastic surgeon. Your idea of “natural” or “pretty” or “proportionate” might be different from your plastic surgeon’s and it is very important for you to feel confident that you are both of like minds as far as the goals. Best of luck to you and I hope you are successful in achieving the enhancement you are seeking.

Ven Erella, MD · Answer

Thank you for your question. Implant size depending on your breast diameter, your goal and anatomy. I recommend you talk to your PS and try the sizers again and decide.

Robert Singer, MD · Answer

The best cosmetic result in any particular breast
augmentation patient depends on a variety of factors, including: Your
individual anatomy, desired outcome, 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. or the type of implant. 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 you find a
plastic surgeon 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

Tom J. Pousti, MD · Answer

My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
One question that might be helpful for you to consider: would you be more disappointed if you are slightly too big or slightly too small after the breast augmentation procedure?
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” or "full C cup” 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 helps. Best wishes for an outcome that you will be very pleased with.

Jeffrey Antimarino, MD, FACS · Answer

Thank you for your inquiry.Deciding on the size of the right implant can be a source of anxiety for many women.   However, in my opinion, the right shape of the implant is more important.   The result you want to avoid is having breasts that are too wide for your body habitus.   Wide breasts will make a woman appear top heavy no matter what she is wearing.    I would recommend discussing this with you plastic surgeon. I hope this helps.

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