Wanting a medium, sexy, full look but not heavy or fake. What CC's would be recommended? (Photos)

Question

I m 34 always needed to do that augmentaion my body measurements are 73kg wt 162m tall ,shoulder width is 37cm my breast base width is 13-14cm nibble to inframmary fold is 6-7cm distance between the two nibbles is 25cm what breat implant is sutiable for me is it 400or 425 cc mentor and i would like to go high profile as i want an upper fulness but with beautiful look not over looking one yaking in consideration that my dr suggest 450 cc

Daniel Barrett, MD · Answer

Dear Creative 999,

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

Robert M. Lowen, MD · Answer

Dear Creative,
  With regard to size, you are 5'3", 161 lbs., breast width 13-14 cm, and nipple to fold distance of 6.7 cm.
You want upper breast fullness and speculate that a high profile implant in the 400-425 cc range (doctor suggested 450 cc) will achieve that. Your photo is from the front only, and we observe that your breast is ptotic (droopy) and the level of the nipple is below the inframammary fold.
   If you went ahead with the plan of a high profile large,  breast augmentation, the following is likely to result:  You will not achieve your desired upper pole  fullness, despite trying with a high profile implant. Instead you will get  a bulging upper breast with the actual breast falling off the implant.  The contour of a high profile implant will also cause a visibile demarcation between the upper chest wall and the implant.  You will have a Snoopy or waterfall deformity when viewed from the side.  The inadequate nipple-to-fold distance of 6-7 cm, insufficient for a 400 cc or more implant will make the  upper breast bulging and Snoopy deformity worse.  The distance should be 9.0-9.5 cm to allow enough skin to cover the lower pole of the breast and allow a round lower pole shape.
  Allowing that we do not have a lateral view to really know where your nipple position is in relation to the inframammary fold, but going on the supposition that it is lower then the fold,  then all the above is corrrect.
   Treatment with these anatomical assumptions means 1. you need a lift, whose design will depend on how many cm of excess skin you have above the areola (you have no excess skin below the areola, and 2. because you have adequate breast tissue and a sufficiently wide breast base, you should strongly consider not using a high-profile implant.
  The attached case shows how the flat top profile of a high profile gel implant can work against achieving your goals, when seen in the upright position.   After getting a lift, you may find that a round Motiva implant, with a full upper profile in the standing position, is something you may want to consider.

Leila Kasrai, MD, FRCSC · Answer

Your surgeon has provided a range of implant sizes based on your dimensions and goals. To determine the best size for you, please ask your surgeon for sizers. These are implants you can fit into your bra so you can see your predicted results.

Please note that if your nipples are located at or below your breast fold, a breast lift would be recommended. Without a lift, no upper pole fullness can be achieved.

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. 
As always, discuss your concerns with a board certified plastic surgeon.

Gary M. Horndeski, MD · Answer

I do not recommend implants but a breast lift using the Bellesoma. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Choosing the right size and profile breast implants for you. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast 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 size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Mehmet Ozdemir, MD · Answer

With a breast base width (BBW) of 13-14 cm, you have a generous frame that can beautifully support larger volumes without looking disproportionate. Your surgeon’s suggestion of 450cc actually aligns well with your anatomy; because you have a wide base, a 400cc or 425cc high-profile implant may end up looking like "narrow balls" on your chest, leaving too much space in the cleavage area. By opting for the 450cc high-profile Mentor, you are more likely to achieve that coveted upper fullness and a more integrated, natural transition because the implant's diameter will better match your natural breast footprint. Since your nipple-to-fold distance is 6-7 cm, you have sufficient skin to accommodate this volume safely, and the high profile will provide the "pop" you’re looking for without the implants appearing overly wide or artificial. Trusting the slightly larger 450cc will likely give you the "wow" factor you want while actually looking more harmonious with your 37 cm shoulder width than a smaller, narrower implant would.

Camille Cash, MD · Answer

Implant selection is best done in person with your experienced board certified plastic surgeon.  In addition to your measurements it's an opportunity to describe (or show photos) to your surgeon of the look you are hoping to achieve and even those you don't like.  Many surgeons have sample implants available that you can "try on" to give you an idea of how you may look after surgery.  I've included a video I hope you find helpful.

Wanting a medium, sexy, full look but not heavy or fake. What CC's would be recommended? (Photos)

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