I would like a second opinion, is 405cc too big for my body? (Photos)

hi  Here are a few tips for you because this is perhaps the hardest decision for a patient to make, as well as the surgeon.  Also see the video attached to my answer.  We spend up to two hours for our BA consults to be sure there is careful communication. We do a full exam in front of a full-length mirror taking six exact measurements.    We put your photos on a large computer screen for imaging, and go over your “ideal-size” photos. We then save this information to your password protected “web account.”

     First and foremost the implant should fit the dimensions of your breast and tissue cover.  Balancing the implant to your over-all body shape and tissue cover is essential.    The main thing is to have the diameter of the implant fit the diameter of your breast "foot-print".  Higher profile implants tend to have a smaller diameter.  Higher is really a marketing term, but often translates into the same volume implant with a narrower base.  Saline implants actually tend to decrease in diameter as they are inflated!  The average size chosen over our last 7,000 breast implants was “350cc”.  BUT, 90% of our patients tell us they wish they were bigger a year after BA.  (We will see you every year for routine checks at no charge.) It’s like your mind incorporates the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc.  You can try on implants in the office by placing them into a special bra.  The implant is also flattened somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for flattening of the implant in the partial sub-muscular pocket.  Once you decide on a size you like, then add on 25cc, because in real life the implant will be flattened slightly by your tissues.  Multiple measurements need to be taken to fit an implant to your exact anatomy.  Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer.  Then you and your surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan.  Keep in mind larger implants tend to have more problems over the years.  Since silicone implants wrinkle less than saline implants, they might be your best bet.

     You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra.  Wear this around the house for a while, and see what you think.  Implant size must square with assessments of tissue cover, breast diameter, and chest wall width.  Multiple measurements of your chest wall are taken (seven in total).  Implant size selection has been an issue of much discussion.

     Therefore, I use a wide variety of methods, but the implant size is always established preoperatively.  Also, patients are advised to bring reference photos demonstrating their ideal size and shape.  A photo album of patient pictures is maintained to assist them.  These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery.  In determining the final size selection, I always place the highest priority on the preoperative measurements and potential tissue cover.  Finally, your verbal requests are factored into the analysis.

     We use the quick-recovery approach, so click on the web reference link below to have this explained and you can see the list of Quick-Recovery (Flash-Recovery or Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery journals.  It is a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs. It causes far less trauma to surrounding tissue than traditional approaches, and it dramatically reduces pain and recovery time. In published studies of BA patients, 95-percent of women interviewed after the procedure returned to normal daily activities within 24-hours. Quick-recovery BA is not a “gimmick.”  These specialized techniques, which actually speed recovery and get you back to your daily routine, kids and work, are published in our plastic surgery journals.  Because these PS journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science. Therefore, these are sound techniques, not marketing hype. 

     Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons).  Also, ask if the PS has an established, high volume breast augmentation practice, performing several hundred breast augmentations each year.  Be sure the PS has been in practice for a while, about 20-years might be a good gauge.  Does the PS offer all three incisions?  Discuss the implant type (gel or saline), shaped "gummy bear" or non-shaped, smooth or textured, implant pocket (over or under the muscle) and the "quick-recovery approach."  Ask to see their before and after photos if you didn’t see any on their website.  If they are experienced, they should have several 100 breast implant patients for you to view.  I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you.  You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center.  Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.      

All the best, “Dr. Joe”

 

 

Thank you for your question.  I do think around a 400 cc implant would bring you close to your goal.  Depending on the measurements of your breast would determine if you should use a moderate plus implant vs a high profile implant.  A high profile implant will help more with the upper pole and potentially able to use a slightly smaller implant.  Best of luck to you. 

Hello dear!
Thank you for your question and provided information as well..
Based on your photos, it seems that you have symmetrical breasts for which you wish to add more volume. There are many ways that plastic surgeons perform measurements in order to determine which breast implant size, style and shape will best suit your goals. It is important that you communicate to your board-certified plastic surgeon what are expecting, to make certain that your goals are realistic. It's helpful to show pictures of results you'd like, but please keep in mind that these are other people and your body is different from everybody. In my office, we use a method of sizing with silicone gel forms of known volumes. This is proven to be a very accurate means of determining what size will might be of additional interest to you as well.
Know that 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.   
Hope this helps and best of lucks.
Dr. Luis Mejia.

After I measure and discuss goals with my patients, we then look at pictures of former patients with similar measurements with different size and style breast implants. My patients tell me that this process is very helpful in determining what size breast implant is right for them. Saline will help  get the largest size possible for you.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author                          
RealSelf Distinguished Hall of Fame Inductee

Thank you for sharing your question and photographs.  Unfortunately without key breast measurements it is difficult to comment on your best implant size or profile.  I would recommend seeking out several surgeons for sizing recommendations in order to get the best advice.  Hope this helps.

Breast implant size has nothing to do with bra cup size - which varies with each bra manufacturer.  The average implant volume placed in the US is 350 cc.  A very general estimate is that one cup size is 150 to 200 cc of volume, but realize that no direct correlation exists between the two.None of the modalities to approximate final results from breast implants are 100% accurate; they merely facilitate the patient and the board certified PS concurring on the size and type of breast implant which will come the closest to reaching the patient's goal. My patients prefer to try on sizers under garments they typically wear to determine if they fit as expected and help allay some of their trepidation associated with this decision. When you consult in office with your PS again, ask to try on a profile bra with 450 cc round moderate sizers under garments you typically wear so that you have the best idea of whether the garments fit as desired with the implant selected.  I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy. Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision

Unfortunately, without a direct examination it is hard to say what will work best for you.  Also, the Vectra system is wildly inaccurate in some patients.   If you are C already, a 405cc Implant will place you in the DD range for sure so be cognizant of that.  As far as profile, without direct breast measurements, it is impossible to say.  I would have a few more consultations with board certified plastic surgeons and see what they recommend.  I hope this helps.

Hello and thank you for the question.  An in-person consultation is needed to give you a useful advice and I would suggest that you discuss this with your plastic surgeon. Many factors including patient's desired breast size, skin envelope (both quality and quantity) and breast width diameter among others are important in selecting the implant size. In a typical consultation, you try a variety of in-bra sizers and in combination with several other measurements that your surgeon will do, the final implant volume is selected. Use of 'goal pictures' is  also an effective way to communicate your goals with your plastic surgeon. My best advice is that you communicate your goals and aesthetic ideals with your surgeon as clearly as possible and trust your surgeon's skills and abilities to deliver what you are looking for.
Best wishes and good luck,

Pejman Aflaki, M.D.

Johns Hopkins-trained double board-certified plastic surgeon

Dear Generous86478,
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

If you are wanting to go up just one cup in size, then 405 cc's is too large. I would suggest going back to your surgeon and asking to try on that size so you can get a better idea of the size and of the weight of that implant.