Is 500cc too big for my frame? (Photo)

Question

I’m 5ft3/160cm and weigh 111lbs. I have a petite figure, currently with small bust at A/B cup. I’m wanting to achieve the rounded, almost ‘stuck on’ look, but am worried the width will be too wide for my frame? I had a consultation and was told 500cc, high profile will be ok on me as my maximum. Is this righ for would you recommend I go smaller?

Donovan Rosas, MD · Answer

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing.  Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.  
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." Communication is key as you and your surgeon create your custom surgical plan. 
Based upon your photos/goal photos, you are seeking a dramatic less "natural" result. A HP device is recommended. I tend to favor conservative sizing. However, when considering your goal photos a HP 500 ml does not seem unreasonable.
As always, discuss your concerns with a board certified plastic surgeon.

Daniel Barrett, MD · Answer

Dear honeybellex,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Leila Kasrai, MD, FRCSC · Answer

Have you tried on sizers? Sizers are implants you can put into your bra. You’ll be able to get a better understanding of how you may look and feel after your surgery with 500cc.

Azita Madjidi, MD, MS, FACS · Answer

To answer your questions, one has to measure the width of your chest. It cannot be done on a picture. Then your surgeon needs to see on the chart of the brand you are interested, to see your options for the width of your chest. If your chest is narrower than the implant, it will either go over your chest bone and risk symmastia or fall in your arm pit.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

500 cc implants weigh 1/2 a kilo each and are quite large. If you are size 32 or 34, each 100 cc of implant corresponds to 1 cup size change. 500 cc implants would take you up 5 cup sizes. Implants this large will not fit under the muscle and will extrude inferior and laterally. I recommend smaller implants in the order of 200-300 cc implants which will look appropriate for your figure.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

A 500cc implant on your small frame will look large but without examining you it's not possible to say if it is too wide for you. I uses sizers during surgery to help select the implant that fits best in the breast space and best matches my patient's goals for surgery.

Connie Hiers, MD, FACS · Answer

The 500 cc implants will be too large and heavy for your frame and tissue and may just look like big balls on your chest. Please go smaller. Plus, that large size will stretch and thin your own tissue too much and you will sag over time.  That size will also be heavy on your neck and shoulders.

Mats Hagstrom, MD (license on probation) · Answer

Implant size is best determined in conjunction with your provider.
Each plastic surgeon will have their own way of guiding patients through implants selection process.
From your picture, you breast have pretty good diameter so you could conceivably work with fairly large implants without having excessive risk of problems.
That said Whenever patients or surgeons choose excessively large implants the chance of undesirable, side effects, complications, and the need for revision surgery will always go up.
This is especially true if the implant is simply much bigger than the natural diameter of the breast.
It’s always safer to stay on the more modest sidebut this needs to be balanced against patient coming back for secondary revision surgery, increasing implant size that may have been unnecessary if the implant size was well-made the first time.
The chance of complications and needing revision will always be lower when working with more modest size implants.
Once the tissues are stretched out, it becomes more complicated to go down in size later.
My personal preference is generally to use more modest size implants, but patients often want bigger implants than what I would personally choose.
I typically respect the desire of my patience, but also inform them of the risks with using excessively large implants, especially long-term.
Each plastic surgeon will have their own way of determining the final implant selection.
My preferred method is to work with before, and after pictures of previous patients who had very similar body characteristics.
I typically ask my patients to bring in a number of before, and after pictures they consider ideal.
I ask my patients to select examples of previous patients who have very similar body characteristics to their own.
Once I have a clear understanding of what the patient is hoping to achieve, I bring those pictures with me to the operating room.
During surgery I use temporary sizers. I typically have a full selection of implants at my disposal during surgery and select implants based on which sizer gave me results. Consistent with my patient wishes.
I found this to be the most accurate way of implant selection.
Some providers ask patients to make the final decision, and only bring one pair of implants to the operating room.
Some providers guide patients through the implant selection process better than others.
 Each provider will have their own way of doing this.
Generally speaking, I always encourage people to have multiple in person consultation before selecting a provider.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own.
 An experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, only representing the best results of a provider career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures they’ve actually done.
 Ask each provider what their most common indication for revision surgery is, what their revision rate is, and what their revision policy is.
All plastic surgeons, including the very best due revision surgery.
Claiming to have a zero revision rate is hardly ideal.
It generally means providers are not willing to go the extra mile to get the best outcome for their patients.
 be careful with providers who need to correct implants that have bottomed out from their first procedure.
This undesirable side effect represents anatomically poorly placed implants, and should not happen in the hands of sufficiently experienced providers.
There’s no correct number of consultations needed to find the right provider.
The more consultations you have the more likely you are to find the best provider for your needs.
The biggest mistake patients make is having only one consultation which more or less eliminates the ability to choose the better provider.
 Breast augmentation outcomes are generally based on three different variables.
The first variable is the patient’s candidacy for the procedure.
Individuals who have breast a symmetry, breast that sit wide on the chest wall or have nipple divergence, may not get the same quality outcome as those who do not.
There are a number of variables that change someone’s candidacy for this procedure.
 Nipple divergence will be amplified with the placement of large implants, especially high profile implants. (Your right breast?) 
The second variable is implant selection in regards to size, shape, and type.
The third variable is the surgeon ability to place the implant in the correct anatomic location.
My personal preference is sub, pectoral placement, leaving as much of the implant covered by the pectoralis muscle as possible.
Best,
Mats Hagstrom, MD

Is 500cc too big for my frame? (Photo)

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