Very tall woman (6'2") and breast augmentations. Need help deciding on a size (Photo)

Question

Hi, I am in the adult industry so I am looking to get a larger implant but nothing grossly big. I have very Wide hips about 39 inches , 28 inch waist, 36c or 34d just depending, and am 6'2. While pregnant I got as big as a 36E so I do have extra skin that I know can stretch out. I know 600 cc is usually considered pretty large but considering my height I am thinking that may get me the look I desire. What size do you suggest for the results I would like ?

Stan M. Valnicek, MD · Answer

Thank you for your question.
Sizing is a very complicated issue.  Patients often want an implant that gives a certain look but there are so many factors that influence that.  Natural breast volume and density, skin quality, IMF position on the trunk, ptosis of the breast tissue, width of the breast base, rib cage slope and many others.
With respect to taller patients, a larger implant is generally needed to balance with the increased shoulder to hip distance.  The increased implant vertical height might come with more implant width, and too much lateral fullness. One can use shaped textured implants that are taller and narrower but this introduces other potential issues.  
You have a bit of ptosis of the breast tissue after the pregnancy.  A lift might help this - or the implants could be placed lower to sit properly under the breast tissue.  Lower implant placement leads to less support and affects the longevity of the position.  Large implants also load the tissues more and it is harder to keep them in place in the long term.  
It is always best to see a reliable board certified ASPS/ASAPS member in your local area for an opinion.  Do the sizing at least twice and bring a range of clothing, bathing suits, tight T-shirts, etc..  Also, a lot of photos that patients bring in are of ladies in a supportive bra or in the first year after large implants.  None of these reflect the reality of things - and how things look in clothing do not always reflect the appearance unclothed or over time.  Finally, you should consider the timeframe and evolution of your career: how big is big enough and how long do you need to be at that size.

Robert M. Lowen, MD · Answer

This answer to this question is usually based on the basic anatomy, evaluation of skin laxity, and the volume of existing breast tissue, as described by John Tebbetts, MD in the High-Five method.
If you have a base width of 15 or so, for example, and a nipple fold distance of 10, and laxity of > 4 cm on anterior pull, this would give a volume of about 520.  This would give a full breast, considering that you already have a fair amount of volume.  An individualized exam is necessary as these are guidelines for an aesthetic result.

Daniel Barrett, MD · Answer

Dear mzholmesyarb,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 goalsDaniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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 question, it is important to remember that sizing is not merely a question of having the available skin to accommodate the increased volume. You must have the space on your chest to fit the device. Exceeding the BWD will lead to the implant spilling over into the axilla. 600 cc is a large device but it may be reasonable depending on your unique measurements. Taller patients can often tolerate volumes that would be unreasonable in smaller individuals.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Ted Eisenberg, DO, FACOS, FAACS · Answer

What you are thinking might be right. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I do that with my patients, we then look at pictures of women with similar measurements with different size implants. My patients tell me that this process is very helpful in determining what size breast implant is right for them.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Curtis Wong, MD · Answer

As you mentioned, your height will allow you to choose relatively large implants that most could not even consider.  Since you're in the adult business, this certainly can have a financial impact on you so choose your surgeon wisely and avoid those that want to limit you to a certain size, yet realize that the biggest of implants can cause trouble down the road where you may need to downsize and require a lift then.  But I certainly understand the need take advantage of the situation as much as you can and would have no reservations with going with what you want, provided the base will fit on your chest and not create other problems like symmastia.

Douglas J. Mackenzie, MD · Answer

600cc is not unreasonable given your body frame and height and the photo example you posted.  However, your current shape and the fact that you were an E cup during pregnancy is a little concerning as to how stretched your skin and breast tissue is.  Only an exam can tell.  Consideration might be given to going submammary as opposed to subpectoral, and a mastopexy (concentric or vertical) is a possibility.

Tim Sayed, MD, MBA, FACS · Answer

You will get the best answer to your question by scheduling an in person consultation with a plastic surgeon certified by the American Board of Plastic Surgery and discuss your unique situation and concerns. The surgeon would meet with you and examine you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of the operative procedure in person and what to realistically expect. Then you can make an informed decision on size and shape. Your surgeon should be able to explain to you why they are recommending the size they are according to your current breast measurements including your chest width and your desired outcome.We have all our Breast Augmentation patients not only utilize our 3D imaging so they can get a real visual on what the implants will look like on them but also to actually try on the different size implants with a tight bra and t-shirt to see what they might expect. That way they have a good visual of what a 450cc implant will do as opposed to a 350cc implant for example. You want to make sure that you see a surgeon that will listen to you and your goals for the procedure and discuss in detail their recommendation for size and shape not only taking into consideration your desired outcome but also your breast measurements before the procedure including your chest dimensions. And then let you try the implants that they feel will give you the desired result so you are in agreement with the size.

Tom J. Pousti, MD · Answer

Thank you for the good question.
 As you can imagine, despite your good description of body type and goals, it is not possible to give you precise advice online.
 Having said that, in my practice I have found that taller patients DO end up with larger breast implants (that seem to fit their frames better than smaller breast implants would),  when it comes to achieving a proportionate look.
The best online advice I can give to ladies who are considering breast augmentation surgery 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're 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. I have found that the use of words such as “natural” or “D or DD 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.

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.
I hope this helps.

Ronald V. DeMars, MD (Retired) · Answer

It is not possible to choose the best implant for a patient without an exam. Show your surgeon photos of surgery patients that have the look you prefer and if it is realistic, the surgeon will find the appropriate implant. That's his job and is based on years or decades of experience. If the surgeon makes you choose the implant, with absolutely no understanding of all the factors that go into getting the right look for you, find another surgeon.

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