I'm 5'8", weigh 160 lbs. What implant size would you recommend? (photos)

Question

I know this is a common question, but thought I'd give it a shot. I'm 5'8", weigh 160...bwd is 16. Dr originally suggested 600 cc round silicone unders (lowest profile). When I tried them on, they just felt big! I run actively, approx 20 miles/week. I don't want to have issues running by going too big. I want upper pole fullness that comes with the implant added to a lift. I tried on 510 the other day and they "felt" better, concerned they won't fill me out. Thoughts?

Gary Lawton, MD, FACS · Answer

First, the final choice is yours and you have to feel comfortable.  If 600 felt too large, it is a mistake.  Second, if you are concerned about not being filled out, you have to define your goals.The most sophisticated approach to
breast augmentation is through the armpit with a surgical camera (transaxillary
endoscopic). Using this modern approach the space can be crafted under direct
vision, with virtually no bleeding and no postoperative bruising. Most
importantly, the shape of the breast is meticulously created. The other, older
methods of insertion are technologically less advanced. Both silicone and
saline implants can be placed through the armpit by a surgeon with skill and
experience using this approach. The incision in the crease is the oldest method
of placing the implants and puts a scar directly on the breast.

A round implant would be a better
choice because they move more like breasts. The anatomic implants have a
textured surface which makes them feel very unnatural. In addition, there is no
benefit to anatomical. There is an X-Ray study that shows the implants from the
side at 6 months. Standing, the round and the antomical implants have the same
profile. When you lie down however, the anatomical implants do not change,
which is unnatural. A round implant will change when you lie down, like a natural
breast would.

HP implants, which are a more modern
shape than moderate profile implants, fit most women better. They have a more
appropriate base diameter and can be made to look very natural or very
augmented, depending on where in the range the implants are filled to achieve a
particular volume. High profile implants are the first choice in my opinion. I
rarely find an indication to use moderate or moderate plus implants. The
subtlety in the final outcome is not achieved by which profile implant is used,
it is determined by the skill in the creation of the pocket, the choice of
volume, and where in the range the implant is filled.

There
are many advantages to sub muscular dual plane placement and very many
disadvantages to sub glandular placement.  I would see no indication to do
anything but sub muscular dual plane.  Subglandular silicone implant
placement is the historical approach to this surgery, and was widely used in
the 1960's.  The implant edges are more visible, the risk of rippling is
higher, the implant is in contact with the non-sterile breast tissue so the
risk of infection and capsular contracture is higher.  The interface
between the breast tissue and the muscle is blurred so the implant interferes
with mammography more than sub muscular placement.  The blood supply
surrounding the implant is worse so the risk of capsular contracture is higher.
 The support for the implant is less so there is more long term shape
abnormalities and sagging.  The look of a sub glandular implant is much
less appealing than a sub muscular implant.  The placement of sub
glandular implants makes any subsequent revision surgeries more complicated and
less successful.  There are no advantages to sub glandular implant
placement.

The choice between saline and silicone
is one that requires a complex discussion of all of the advantages and
disadvantages of both implants. The issues to be considered are safety,
density, mobility, rippling, rupture rate, consequences of rupture, detection
of rupture, need for follow-up care, cost of follow-up, appearance, feel,
sensation of heaviness, radio-density, mammograms, and costs, among other
things. There are advantages and disadvantages of both products. The decision
will ultimately be up to you based on what is appropriate for your particular
situation. Beautiful results can be obtained with either implant.

The best way to determine the size that
fits your personal perception of the perfect breast is to try on sizers. This
way you can see how they fit on you, how they add to your current volume, and
whether they fit your frame. Although the surgeon can guide you, only you will
be able to tell what is the right size. Try on sizers. Measuring a diameter and
then telling the patient what volume they can have (in high, moderate or
moderate plus implants) in my mind is backwards. The patients should be allowed
to choose the volume. Then the surgeon carefully considers the base diameter,
projection, profile, manufacturer, and fill material that will achieve the
patients goals of size as well as qualitative look (natural, intermediate, or
bold upper pole fullness or projection), all the while taking into consideration
the patient's anatomic features that will affect the outcome. The experience of
the surgeon and the degree to which they explain the options to you is of
utmost importance. The subtlety in the final outcome is not achieved by which
profile implant is used, it is determined by the skill in the creation of the
pocket, the choice of implant. Don't let the doctor tell you what would look
good on you. They cannot tell what you perceive to be the best size. There is
no maximum. That is up to you.

Gary M. Horndeski, MD · Answer

Your photo didn't come through. Please remember that the bigger the implant the heavier it will be, thus the sooner you will need a revision. If you are already in need of a lift, you may not need implants to achieve upper pole fullness. The Horndeski Method (TM) can achieve this for you without implants or a vertical scar. If you enjoy an active lifestyle, large implants will not be advisable.Hope this helps.Kind regards,Gary Horndeski M.D.

Jerome Edelstein, MD · Answer

Since you're physically active, you may not want to go with 600cc because it could be great bothersome while you run. How about trying on a variety of sizers between 510 and 600 to see what looks best on you? You can also see if your surgeon does dimensional breast augmentation, where a number of measurements are taken to determine the most proportionate size.

M. Scott Haydon, MD · Answer

Thanks for your question. While I can't see the photo attached I can assure you that a 600CC implant is going to really cramp your style. I find it hard to believe that your base diameter is 16cm, but perhaps it is. I would suggest a 2nd opinion. There is an ideal size for you out there. Best of Luck!

Jennifer Lauren Crawford, MD · Answer

Thank you for your question.  For some reason, I am not able to view your photo.  But, your chosen implant size may be a bit incompatible with your running life.  I always explain to my runners how the implant volume and weight can affect the way they feel while being so active.  Keep in mind, a 350cc (one of the most common implant sizes I use) set of silicone implants already weighs a bit more than 1.5 lbs.  Implant size is best determined after measuring an assesses the patient's current tissue and listening to her goals.  Seek a second opinion if you are unsure or just go back into your chosen plastic surgeon's office to discuss the sizing again so that expectations are in line.  I am attaching a link to a blog I wrote about breast augmentation.  I hope you find that it covers a lot of bases for you.  Good luck!

Aldo Guerra, MD · Answer

Hello jlgab345. Thanks for your post. I could not see the photo for some reason, but here are some thoughts. As far as sizing:1) My philosophy includes guiding patients to explore reasonable options for breast implant size, usually two to three similar sizes, which allows the patient to visualize how different volumes affect their breast cup. 2) The best guide for a final breast implant size recommendation is derived using measurements from the patient’s own breasts and chest. 3) When measurements are considered then options for sizes can be presented. 4) I use the Mentor Volume Sizing System of breast sizers to demonstrate how these different volumes will look on a patient’s body. 5) This methods offers good reliability and is simple to use, but is not perfect.In addition, you're a serious runner. The 600 seems incompatible with a runner's lifestyle. Even the 510 seems a bit big for someone that runs 20 miles per day. Upper pole volume should be nicely improved as well with sizes that allow you to continue your athletic lifestyle. Best wishes, Dr. ALDO.

Louis Potyondy, MD · Answer

Implant size is always a difficult and personal choice. On the one hand you don't want to be "too big" but you need the volume to fill out the skin envelope. Based on your size 600 cc does not seem unreasonable. Personally I prefer a higher profile but there is nothing wrong with a moderate.Another consideration is if you need a breast lift. Pictures were not available to confirm, but often if you do a lift you can get more upper pole fullness and possibly get away with a smaller implant and still look filled out.

Ven Erella, MD · Answer

Thank you for your question. Foe some reason I can not see the picture. Your implant size may be a bit bigger with a runners like you. I recommend to get another opinion.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  Online consultants will not be able to provide you with specific enough advice to be truly helpful. Ultimately, 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, and computer imaging) will be critical.  Best to discuss your goals, expectations, concerns, and questions directly with your plastic surgeon, preferably prior to the day of surgery.
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 words such as “natural” or "C or D cup” or "too big" 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 (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Alfonso Gonzalez Cepeda, MD · Answer

Thank you for your question. In my professional opinion, the best way to find the ideal breast implant size depends on many factors. I take special measurements of the breasts and also the overall body. I am looking for balance for the overall body. Another factor that I take into consideration is the patient`s lifestyle and personal expectations. I will use these factors in helping a patient find the ideal size. The advantage that you have is that you can try on sizers to see what your final results may be like. If the 510 feel better to you, it might be the best choice. Also please remember the larger the implant is, the heavier it will be. If you are a runner, it may feel uncomfortable if you run. You will need a good secure sports bra to conserve the shape of your breasts. It is important to consider all the facts before making a final decision. When you have doubts, it is better to take your time and ask as many questions as you need. Sometimes a second opinion is needed to be sure. Good luck!

I'm 5'8", weigh 160 lbs. What implant size would you recommend? (photos)

Answers (10)

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