My surgeon measured my breast width at 15CM. He wants to put in 13CM, is this too small? (photo)

Question

I discussed my goals.. More Upper Pole & more Projection and firmer implant. Doctor is suggesting a 2 inch increase in projection. A more firm implant and greater upper pole. This is an implant replacement. Last implants were put in 33 years ago behind the mussel. 325CC. I have went from a size C after first surgery 33 years ago to now a DD. I have gained 20 pounds since my first surgery. I am 63 years old. 5'4 130 lbs.

Stefan Mark Szczerba, MD · Answer

I like conservative measuring!  Additionally too wide of an implant just doesn't look right.  You want approximately 1-2cm on each side of the implant to be well covered with breast tissue.  You also have the luxury of having a know starting point of 325cc.Firmness is now custom decision now with Allergan implants.  Mentor implants have that option but more based on the fill of the shell rather than cohesiveness of the silicone.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Depending on what your goals are you could compare the dimensions of your current implant to the ones discussed with your surgeon to see if it is wider as well as more projecting, while maintaining a thicker gel consistency for shape.  Also important is to rule out the need for any lift to help remove loose, or excess, skin that has developed over the 33 years and weight changes.  Hope this helps.

Gary M. Horndeski, MD · Answer

Since you have gained weight since your previous surgery and are 63 years old, the technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided and nipple sensation (in 95%) is maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Pioneering1866,
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

John LoMonaco, MD, FACS · Answer

Thanks for the photos. Over time, your skin has stretched and the breast fold is longer.  A lift to re-arrange the internal tissues higher and remove excess skin while also using a small implant would be the best way to get you a shorter, rounder breast with fullness up top.An implant alone is also an option, but will require a larger implant, and to get a "hand in glove" fit of the implant to your breast (which I prefer) you would need a larger implant which might be a bit flat.  A rounder, higher profile implant would be quite a bit larger.  If you are OK with going up by 200cc this may be OK. Otherwise a narrower implant may be needed. This can also be OK, but you'll need to discuss that issue with your surgeon as it requires a careful exam and planning.

Adam Tattelbaum, MD · Answer

Thanks for your question. Over time things change. It is not uncommon for the natural breast tissue to head south -- weight and time contribute to this.  Some patients may need a formal breast lift, but others may get some lift out of a slightly larger implant or one that has more fullness in the uppper pole as your PS suggested. If that is the route you take your ps will likely choose an implant of greater diameter and projection compared to what you have now. The caveat is that you have to want to be bigger.I fiind it helpful to try on actual implants in a testing bra for my patients.  Unfortunately that is not possible when you already have implants in place. If your implants are saline your PS could deflate them in the office (A small needle stick to suck out the water) and then you could see the size of your natural  breasts and do sizing.  If your implants are silicone you and your ps will have to agree upon sizing based upon his or her judgement.Hope this helps.I have included sizing info in the link below as well.

Paul Banwell, BSc, FRCS(Plast) · Answer

Thank you for your enquiryYou look fantastic and it is probably extremely sensible to exchange your implants. You do not comment on any symptoms but as I am sure you have been told, there is always a chance of silent rupture of implants this old.Regarding your choice of implant and size, this is very much down to yourself and your surgeon. Trust their experience. You are petite and a 13 cm breast implant is still quite wide so I am sure you will be fineGood luck!

Stephen M. Davis, MD, FACS · Answer

Thanks for writing,Base width is just one of many things that are taken into consideration when re-augmenting. This is the point where you trust your surgeon and after close discussion, he and you come to a reasonably obtainable goal for surgery and an understanding of outcome. I hope this helps.Stephen M. Davis, MD, FACSCertified: American Board of Plastic SurgeryMember: American Society for Aesthetics Plastic SurgeryMember: American Society of Plastic SurgeonsMember: RealSelf Hall of FameVERIFIED: Plastic Surgeon

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  
 There are no hard and fast rules when it comes to diameter of breast implant versus diameter of breast (band width). In other words, these measurements are useful but are only one of the many factors come into play when it comes to selection of appropriate breast implant size/profile.  Remember that plastic surgical procedures are both art and science;  different plastic surgeons will have different techniques and sense of "artistry".
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.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.  Show your plastic surgeon what your goals using as many visual aids as possible.   As you can imagine, terms such as "natural" or "fake" can be interpreted differently by different people. This additional communication will go a  long way when it comes to helping alleviate your anxiety prior to proceeding.
 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.

Mahmood Kara, MD - Account Suspended · Answer

Hello. Thank you for your inquiry. It is important to have an in-person assessment regarding your concerns as it is difficult to determine virtually.

Exact end results and cup sizes are usually quite difficult to calculate as everyone has a different starting point.

There are many different factors that go into choosing a breast implant size which will correspond with your body dimensions while concurrently achieving your aesthetic results. Some of these factors are: Implant size (CC's), Implant profile (Low, Moderate, High), Placement of the implant (Subglandular vs. Dual Plane) etc. We utilize smooth round cohesive silicone gel 'gummy bear' implants for the best results.

During a consultation your aesthetic goals are heard and taken into account with the measurements of your breasts and the integrity of your tissue, as well as level of ptosis (sag). From here we collectively can find your 'perfect fit'. You are able to try out sizers and different implants in our office such that you can get an idea of what size you would be post-operation. We also offer Crisalix 3D plastic surgery virtual simulator during our in-person and virtual consultations to preview potential results. After your consultation, you will receive your very own implant sizers to take home with you (at a small cost) whether or not you decide to go forward with your procedure.

I usually recommend that my patients stop smoking, take vitamin C daily, and avoid aspirin/ibuprofen and vitamin E 3 weeks prior to surgery. I specialize in the 24-hour Recovery method which minimizes trauma to the breast and decreases pain post-operatively.

We encourage you to look at our website and Instagram (drkaraplasticsurgery) for lots of before and after pictures!
Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery.

We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!

M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind
Hello. Thank you for your inquiry and congratulations on your surgery! It is important to have an in-person medical assessment regarding this issue as it is difficult to determine virtually. Continue to update your doctor in the matter and follow their post-op protocol.

Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery. We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!

M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind

My surgeon measured my breast width at 15CM. He wants to put in 13CM, is this too small? (photo)

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