Would getting 650cc implant be a mistake? I am 5'7, 135 lbs. (photos)

Dear becca_nath18,breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  650cc is a large implant.  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

Unfortunately, you
have not told us your bra size.  650 cc
implants weigh about 1 ½ lb each and there is no way your skin envelope will be
able to handle that weight over time.  The
FDA has declared implants non-lifetime devices but in your case, it will be a
very short time before you will need revision. Best Wishes,Gary Horndeski, M.D.

Without a direct examination, it is hard to say what will work best for you.  So much depends on your own breast tissue, chest width, and frame.  At 135lbs and 5’7, you appear to be pretty lean meaning an implant that size will look pretty big.  I wouldn’t use the computer simulation they provided - I can tell already that you will not look like that with that much volume added. You will be larger than the picture shows.   The other thing that you really should think about is the axillary approach.  Most board certified plastic surgeons stopped using this technique a while  ago since published studies show it has a much much higher 1 year and 5 year complication rate compared to the breast fold.  The best thing to do is to have another consultation or go for a second opinion so that you can really feel comfortable with your choices. I hope this helps.

Based on your photos and your frame I would consider those implants to be too big. The long term problems of implants that size are excess stretch and thinning of tissue. I generally don’t put implants that size in augmentation patients 

To create more certainty with your decision, I recommend an additional consultation with a plastic surgeon to discuss your goals and be measured. After doing that, my patients and I look at my actual patient pictures of women with similar measurements with different size implants. My patients tell me that this process is very helpful and reassuring in determining what size implant is right for them and what can realistically be achieved.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Thank you for the question.   
You are correct: every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery. The use of a larger breast implant (than what is safely "allowed" by the patient's anatomy) can be problematic;  potential problems include breast implant displacement/malpostion issues ( such as bottoming out, lateral displacement, symmastia...)  and/or significant breast implant rippling/palpability.
Ultimately, careful selection of plastic surgeon and 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 know words such as “natural” or "C or D 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.

There are 4 basic questions that need to be answered before breast implant surgery:Location of scar (incision)Above or below the muscleType of implant (saline/silicone, round, anatomic, high profile, etc.)Size of implantThe hardest decision to make, BY FAR, is the size and style of the implants. Choosing implants based on a projected bra size is a poor way to choose the size of the implant.  The choice should be made based on the look that you want to achieve and then you can find a bra to match.  It is not about bra size, it is about breast appearance.  Please see a board certified plastic surgeon who performs breast implants frequently to help with your decisions.  The size selection seems reasonable to me.Good Luck!

Hi and thanks for your question.  The best evidence that the size isn't too big is if you like the look with the sizers.  The actual number doesn't matter as long as you like the look.  Best wishes on your operation!