Help! Would I be able to go from 32B to 32D/32DD? What size implants would it take to achieve this?

Question

Why are there 400 cc implants that look huge, sometimes even bigger than, for example, 550 cc implants; and vice versa? I'm about 5'7 and 135 lbs. I'm a 32B and I would like to be a 32 D- 32DD but I'm not sure of what size implants I would need to achieve that while still keeping things natural looking. I'm looking to get round, high profile, silicone, under the muscle with incisions in the crease.

Lawrence Iteld, MD · Answer

We have found that a combination of 3D imaging (Vectra) and use of bra sizers allows women to accurately choose implants to achieve their goals. Since no two women have exactly the same breast shape, chest anatomy, etc, an in person assessment is essential.

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. 
With regards to your specific concerns, different implants look different on different frames. One must also consider the pre-operative volume of the native breast. Bigger breasts will get bigger as the result is additive.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

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.  Your goal of a 32b to 32 D/DD is likely very reasonable.  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

David Shifrin, MD · Answer

Hi great question. Each patient has a different body makeup which affects the way the volume in the implant is perceived when implanted. In other words, a heavier woman needs a larger implant to look like the same size increase as a skinny woman. Your surgeon should be helping guide you in your implant selection. Best

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.

William Rahal, MD · Answer

To answer your question about 400cc vs 550 cc, you need to take into account what's known as your base width diameter.
Imagine lying on your back and drawing a circle around your breast. If you were to draw a line across that circle, it will be a given length. Your plastic surgeon will measure this length, which is called ‘’base width diameter’’ or BWD for short. 
 
For women, the base width diameter can go from 9.5 cm to 16.5 cm, or 3.75 to 6.5 inches. As you can see, there is a very wide range. 
550 cc on a woman with a BWD of 10 cm is very different than 550 cc for a woman with a BWD of 15 cm. On one it may be too much volume in too little space, and for the other it may be even less than the max she can safely go. 
Regarding sagging, whether you have implants or not, aging, pregnancy and breastfeeding will do things to your body. When you’re pregnant, your body releases more hormones. You’ll gain weight. Your skin will be stretched by the pregnancy weight and lose some elasticity.  And after childbirth and breastfeeding, your breast will deflate and your skin will be looser. 
Now, there are two major unpredictable factors surrounding these changes I just mentioned. First, the DEGREE that these changes will occur is unpredictable. We don't know and can't know ahead of time, how much your breasts will deflate or how much looser your skin will become.
 
And second, it is unpredictable whether these changes will warrant a procedure. Maybe the deflation will be mild and not warrant a breast lift. 
 
So given these two unknowns, it is impossible to predict whether how much you will sag. But note that If you already have a breast augmentation, the implants will not affect those factors. 
I hope that answers your question the 500 cc volume and sagging. It’s great that you’re doing this research. I always say that the best patients are informed patients.
You might also want to research your options for breast implants. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you?
A term that I use with my patients for the perfect implant is the “Pony Implant”.
So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural.
Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small.
And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!"
That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours.
This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it.
Thank you for reading and best of luck on your journey!

Jason M. Petrungaro, MD, FACS · Answer

Choosing the right size implant is one of the most important parts of a breast augmentation.  With that being said, I always tell my patients to avoid focusing on the actual number in terms of implant volume.  You should focus everything on whether or not you are happy when you look in the mirror.  When you find the implant that does this, then that's your number.
Going from a 32B to a 32D or 32DD is absolutely possible.  It is important that you consult with a board certified Plastic Surgeon who can take the proper measurements in order to help you choose the right implant.  If you want to achieve an augmented yet natural look, then your surgeon will make sure you do not choose an implant that is too wide for your frame.
High profile implants are an excellent choice.  Most surgeon will implant moderate plus versus high profile implants.  The higher the profile, the more the implant will project, or "stick out", from your chest.  High profile implants give a bit more upper pole fullness and I find my patients are very pleased with the outcomes.  The reason that some implants appear larger than others even though they have less volume is likely because they are a lower profile, which means they are wider.
It is impossible to recommend a size for you with an in-person exam; however, if you are looking to go from a B cup to a D or DD cup, then you are likely looking at the 400 mL +/- 25-50 mL range.  Choosing a surgeon with a sizing system (we have the Mentor sizing system) is very helpful because you can "try on" different implant sizers under your bra and see how they look in the mirror.  It is actually a very accurate and helpful way to choose your implants.

Steven Wallach, MD · Answer

Implant volumes do not always match up accurately with cup sizes. You can do a baggy test with the bra you want to fill to give you a rough idea of the volume that you will need.

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 sit at a preoperative visit will help you and your surgeon choose the optimal implant.

There are no manufacturers' standards for cup sizing in the bra industry. The cups of a 32 DD and a 38 DD are significantly different. Cup size varies from manufacturer to manufacturer and even within styles from any particular manufacturer.

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 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

Peter E. Johnson, MD · Answer

The number on the implant can be very deceiving, and it is very true, the same implant in two different individuals will give a different result. The anticipated cup depends on the skin envelop, original breast size, and the chest size. Rather than stress over the number, focus on the look and communicate this well to your surgeon.

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