What’s the right size? 5ft 8, broad chest/shoulders. (Photos)

Question

Looking for input on the right size for me. I’m struggling to find examples of women of similar size and stature to me to compare to. The goal: slightly larger overall, enhanced cleavage but mainly fullness in the upper pole. 5ft 8 72kg BWD: c. 14cm Good tissue coverage therefore going over the muscle. It’s really important that they look natural, but fit my frame, without making me look top heavy or bulky. It will be mentor implants. Is moderate + a better option than high or ultra high profile? What CC would you recommend? Nipple piercings: can they be reinserted immediately after surgery? (Itll be an incision under the breast I’m getting). Pictures attached of me currently plus my ideal plus what I DO NOT want. Thank you!!!

Daniel Barrett, MD · Answer

Dear happyhouse4959,

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

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. 
With regards to your specific questions:
-If you are seeking "natural" conservative sizing is best
-Ultra HP devices rarely look natural
-Larger above the muscle implants are more likely to look "unnatural" than smaller or submuscular implants
-I would probably focus on devices no larger than 400 ml
-Piercings are removed pre-op and replaced with plastic inserts to preserve the tract
As always, discuss your concerns with a board certified plastic surgeon.

Adam Tattelbaum, MD · Answer

Hard to pick a size on the web. Too wide will make you look heavy and too narrow will look like torpedos. I like to see the curve of the hip be balanced by the curve under the arm. From you photos you carry height and a nice curve of the hips. You have a wider base diameter. I would have been thinking sonthing in the diameter range of a 400- 450 m+. In that diameter you could probably consider a high profile, but would get more implanty looking. Best to try on impland sizers if your surgeon has them.

The site below is being updated but you may find the thinking helpful as well. Best wishes.

The site below is being updated but you may find the thinking helpful as well. Best wishes.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. 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

Tuan A Truong, MD, FACS · Answer

Thank you for your question. The decision to undergo surgery is an important one and scheduling a consultation with a board-certified plastic surgeon will help take measurements, assess your goals and optimize your results. The widened cleavage you have now will likely be improved with a dual-plane technique and moderate or moderate+ profile implants to help narrow the distance. The dual plane will also help keep them looking natural. Higher profile implants will definitely improve the upper pole, but may not improve the cleavage without some fat grafting. Nipple piercings are typically removed before time of surgery to prevent possible infection for 7-10 days. Good luck on your journey!

Camille Cash, MD · Answer

If you are wanting a more natural look going under the muscle is the better way to go.  This also carries a lower risk of capsular contracture.  Higher profile implants will give a rounder appearance than moderate plus profile.  Many surgeons have sample implants available that you can "try on" to get an idea of how you may look after surgery.  Your surgeon will advise when you are cleared to put nipple piercings back in.  The main concern is introduction of bacteria that could lead to infection.  I've included a video I hope you find helpful.

Ahmet Bilirer, MD · Answer

I have reviewed your photos. As you already mentioned, there is a visible lack of tissue in the superomedial area of your breasts. You are a good candidate for breast augmentation with implants. However, due to the lack of tissue in the upper inner area and the downward displacement of your breast tissue and nipple, an augmentation in the subglandular plane is unlikely to provide a satisfying or aesthetic result.
Instead, I believe a dual-plane augmentation would be much more suitable for you. In this technique, both your breast tissue and nipple are lifted, and the implant is partially covered by muscle in the upper part. This reduces the chance of the implant being palpable and also improves long-term aesthetic results.
When examining your breast footprint, we can see that your breasts are set slightly apart. So, achieving the exact look you desire &mdash; with the breasts sitting very close together &mdash; may not be fully possible, but we can get quite close to that outcome.
You also shared a photo saying, “I’m afraid of looking like this.” But that example doesn’t reflect your anatomy. The person in the photo has very small and widely spaced breasts, and the implant was likely placed subglandularly, causing the breast to shift downward and leaving the upper inner area flat.
In conclusion, I believe a 400 cc implant placed in a natural dual plane can give you a beautiful and proportional result.
Also, I recommend removing your nipple piercings before surgery and not wearing them for the first 10 days post-op to reduce the risk of infection.

What’s the right size? 5ft 8, broad chest/shoulders. (Photos)

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