What do you think? 13.5 BWD, 375cc or 450cc, then high or moderate profile, Natrelle Implants? (photos)

Question

I want a smallish "C-Cup".I have a BWD of 13.5 and I only tried on 2 sizes the first one handed to me was (not sure of the profile) 405cc, then the 450cc. I chose the 450cc's, but is 450cc's too big? I most definitely do not want the overly augmented look, but do like the look of perkier breast. I basically want what fits my body best but a 10 yrs younger version of it, if that makes any sense. I am 30 years old, 5'5" 110-115lbs. When I had my son 11 years ago my breast went from 32aa to 34DD literally overnight I never want that size again. My OP date is 5/24/19. Also I was asked about my goal looks so I've included some of those too. So here's the question: what CC's in which profile do you suggest I get to achieve the "goal look"?

Donovan Rosas, MD · Answer

The difference between higher and lower profiles for a given volume is projection and for a given width is volume (with the high profile implant being greater in both scenarios). The moderate plus is the most commonly used profile in my practice. It allows for the most reasonable volume in a given BWD. In my practice, low profile implants are the least commonly used (widest and flattest). I will typically reserve high profile devices for smaller framed individuals or those seeking a less subtle more dramatic change (the opposite of natural). 
In general, the difference between a high and Mod (+), in reality, is very small (on the order of millimeters).  In my practice, I generally classify profile based upon patient preference. A higher profile provides a more dramatic look (size for size) vs. a moderate (+) profile which is relatively more subtle and understated. That being said the vast majority of patients will select a moderate + profile device (especially those seeking a more natural and subtle result).
I often find it is easier to decide on a profile (rather than a volume), this combined with BWD will determine volume. Trying to match a particular volume to a profile may lead a BWD mismatch. In my practice, smaller framed individuals do prefer higher profile devices. I discourage pursuing significant volume as this is a hallmark of the "augmented" or "fake" look. Small girls typically have smaller breasts. Over-sizing leads to a frame mismatch which is not "natural." The difference between mod (+) profile and high profile is subtle and less dramatic than the difference between low profile and the alternatives. Ultimately, it is a choice between more or less subtlety.
With regards to your specific question, HP vs. moderate often becomes a question of subtle vs. dramatic. Most patients do very well with a "middle of the road" profile and chase a higher profile either as a function of a desire for more volume or drama. Anecdotally speaking, I find that smaller framed individuals will choose HP devices as these deliver greater volume in the more limited space available to them.Based upon your photos alone, a 13.5 cm BWD seems high. I would have guessed it to be smaller. This may account for the larger than expected size suggestion of 450 cc. This would be an excessively large implant on your frame. I would suggest a second consultation for repeat measures. I would estimate a HP volume of approximately 300 cc (at most).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic
Surgery, American Society of Plastic Surgeons
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York Jay Yates, MD · Answer

Looking at your photos and measurement overlay it would appear that a 13.5 cm wide implant would be too wide.   Sizing is a complex process that is done differently in every office.   What you have described with trying on implant sizes in my opinion is only valuable to give you an understanding of what general volume you would like.   Deciding the proper implant diameter for any patient is every bit as critical.   The volume at a particular diameter will hint at the implant profile that would fit your frame at that body.   The patients personal preference plays into this implant decision.   For example at 13.5 cm wide you would likely get a very side heavy result.   Although it isn't optimal aesthetics in general it may be your preference and should be discussed.   In my practice, visual confirmation with Vectra 3D imaging is the final step to make sure the patient and I are on the same page with what the chosen implant would be expected to create.   My initial impression of what would get you closest to your goal photos would be something in the 350-375 cc range, likely high profile, possibly moderate plus (depending on the brand chosen).

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  I would tend to agree with the other answers in that 13.5cm breast width may be exaggerated and 450cc may be too large, given your stated goals. Certainly, tissue based planning, taking into account your breast dimensions, tissue thickness/laxity, implant position placement, your desires, and style/projection of the implant are all the important in the decision making shared with you for optimizing your result and meeting your expectations. An in-person physical examination and discussion would be needed to determine all of these.  Given your petite frame with minimal breast tissue and a large/round/very-projecting implant, my fear is that you may get the “overly-augmented” appearance that you do not want. But, I do believe that an excellent result may be obtained with a breast augmentation. Best wishes for wonderful result!

Daniel Barrett, MD · Answer

Dear Bright6618,
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

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate for a breast augmentation.  If you are concerned that 450cc is too large, then 375cc may be a better choice for you.  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.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
 
 Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

William T. Stoeckel, MD · Answer

Most sizing questions about implants really need a physical exam and history to help answer. But I feel confident based on your pictures that a 450 cc implant will not give you the "smallish c-cup" that you have indicated you want. On your frame, a 450 cc implant will be at minimum a D cup. You would have more natural results with about a 300-325 cc implant. I would recommend having another conversation with your surgeon to get more on the same page about what you are trying to achieve.

Ken Dolynchuk, MD · Answer

Hello and thanks for your question and photos. The skin envelope in your case would be the limiting factor. The size of the implant is important when deciding what will look good but equally important is the width of your chest relative to the base width of the implant which is adequate in your case. This plus the distance from the nipple to the lower breast fold will determine where to place the cut in order to prevent the problem of high riding implants. If a plastic surgeon is familiar with these concepts and you are willing to undergo augmentation procedure the likelihood is that your issue can be corrected  with either moderate or high profile implants in the correct volume. You didn't mention what the pocket location was but in your case this will need to partially below the muscle this again because of your lack of upper pole fullness.  But the important thing is not to get fixed on a size. Good luck!

Jeffrey K. Scott, MD · Answer

Thank you for your question. First of all, based on your photos I do not see any way that your breasts base width are anywhere near 13.5 cm. This exaggerated base width measurement appears to be causing what appears to be implant sizing larger than you desire. A 450 cc implant of any profile placed in you would greaty exceed your goals size wise. I suggest you make a visit to your doctor for a “re-sizing” session. For your goals I would anticipate implants in the low to mid 300cc range.

Robert Singer, MD · Answer

The best cosmetic result in any particular breast augmentation patient depends on a variety of factors, including: Your individual anatomy, desired outcome, realistic expectations, a thorough discussion with the plastic surgeon about the options, and an understanding of the pros and cons of any particular implant choice. Proper sizing is not just about the number of cc’s. The thickness of your tissue, breastdimensions which include the width, height, and projection, as well as chest wall width all need to be considered when choosing an implant. Trying on implant “sizers” of various shapes and volumes while wearing a tight t-shirt, bra, or bathing sit at a preoperative visit will help you and your surgeon choose the optimal implant.

There are no manufacturers' standards for cup sizing in the bra industry. The cups of a 32 C and a 36 C are significantly different. Cup size varies from manufacturer to manufacturer and even within styles from any particular manufacturer. Nor is there a direct correlation between implant shape or size and cup size. A 450 cc implant would be large for what you want.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Kenneth R. Francis, MD, FACS · Answer

Dear Bright6618,I agree that 450cc breast implants will give you a larger breast than "smallish C-cup."  On your thin frame round breast implants will also likely be fairly visible.  Consider anatomic shaped implants, but first discuss their risks with your surgeon.  Good luck!

What do you think? 13.5 BWD, 375cc or 450cc, then high or moderate profile, Natrelle Implants? (photos)

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