I'm considering mentor moderate round 255cc or 275cc and can't choose. What are your recommendations?

Question

I'm 5'5", 118lbs, low to mid 12 diameter chest and a small 34c. My surgeon is suggesting 275cc vs 255cc so that I have the breast closeness I want (I don't like it when they're too far apart) but am afraid 275cc will make me larger than I want to go. I want a super natural look and at the absolute biggest would want to be a baby d. Recommendations / thoughts?

Donald Groves, MD · Answer

Hello and thank you for your question. Honestly, a formal in-person evaluation would be needed to determine the best treatment. There are several reasons for this: 
1) Bra sizes vary based on the clothing store (for example, Victoria's Secret tends to upsize everyone by a whole cup size)
2) Most women do not wear the proper exact fitting bra size for their bodies
3) The exact volume (in cc) needed to change cup size is different for different body types (e.g. 32A to 32D requires a different implant size than 38A to 38D)
4) Be careful NOT to fall into the trap most women do- they see a certain implant size (e.g. 285 cc) or perhaps their friend had a certain size, and they want or request this or another size based on that. Everyone's body is different- 285 cc implants on your friend might look VERY different than they would on you. Be very careful not to make this mistake, because the goal is to find the right size and shape for YOU- for your particular body and your breasts.

Because of those multiple factors, and because it is KEY to fully evaluate your breasts in person to make a full set of precise measurements to select the proper implant for you (incorporating factors like amount of breast tissue, implant type, base width, projection, etc), answering your question really would need a formal personalized consultation- to say anything before that would simply be guessing, which would be both unfair and unhelpful to you. Also, just FYI, each surgeon's measurements are slightly different, so numbers, experience, and overall aesthetic from one surgeon aren't necessarily the same as those from another surgeon!

Your breasts are such a KEY area of your body and your femininity- therefore, you should ONLY trust an experienced aesthetic plastic surgeon. As such an expert, I have had extensive training and experience with complex aesthetic surgeries under a multiple world-renowned experts in the field. I’d recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with aesthetic plastic surgery procedures) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Joe Gryskiewicz, MD, FACS · Answer

Hi Atlas,I like the way your PS thinks.  I think you are receiving good advice.  The larger you go the less natural you look. I must say, however, that you are agonizing over 20 cc which is only four teaspoons, so you can't go wrong with way.Here are a few tips for you because this is perhaps
the hardest decision for a patient to make, as well as the surgeon. Also see the video attached to my answer. We spend up to two hours for our BA consults
to be sure there is careful communication. We do a full exam in front of a
full-length mirror taking six exact measurements.We
put your photos on a large computer screen for imaging, and go over your
“ideal-size” photos. We then save this information to your password protected
“web account.” First and
foremost the implant should fit the dimensions of your breast and tissue cover.
 Balancing the implant to your
over-all body shape and tissue cover is essential.The main thing is to
have the diameter of the implant fit the diameter of your breast "foot-print".
 Higher profile implants tend to have a smaller diameter.Higher is really a marketing term, but often
translates into the same volume implant with a narrower base.Saline implants actually tend to decrease in
diameter as they are inflated!The average size chosen over our last 7,000 breast implants was
“350cc”.BUT, 90% of our patients tell us they wish they were
bigger a year after BA.(We will see you
every year for routine checks at no charge.) It’s like your mind incorporates
the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients
that they will experience an increase of approximately one cup size per 200 cc.
You can try on implants in the office by
placing them into a special bra.The implant is also flattened somewhat when under
the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for
flattening of the implant in the partial sub-muscular pocket. Once you decide on a size you like, then add
on 25cc, because in real life the implant will be flattened slightly by your
tissues.Multiple measurements need to
be taken to fit an implant to your exact anatomy.  Have your surgeon's
office show you the charts of the implant dimensions for the various profiles
of silicone and saline from the manufacturer.  Then you and your surgeon
can piece together the puzzle by matching your measurements, with your wishes,
versus your tissue cover and the available implants to arrive at
a surgical plan.Keep in mind
larger implants tend to have more problems over the years.Since silicone implants wrinkle less than
saline implants, they might be your best bet.You can
also approximate this at home by measuring out an equivalent amount of rice
placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and
see what you think.Implant size must
square with assessments of tissue cover, breast diameter, and chest wall width.
Multiple measurements of your chest wall
are taken (seven in total). Implant size
selection has been an issue of much discussion. Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape. A photo album of patient
pictures is maintained to assist them. These photos ultimately help in determining
where the implants will be placed, since they can be shifted inside (to provide
more cleavage), to the outside, up or superiorly, and down or inferiorly during
surgery. In determining the final size
selection, I always place the highest priority on the preoperative measurements
and potential tissue cover.Finally,
your verbal requests are factored into the analysis. We use
the quick-recovery approach, so click on the web reference link below to have
this explained and you can see the list of Quick-Recovery (Flash-Recovery or
Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery
journals.It is a surgical procedure that
uses special instruments and techniques to minimize tissue damage and avoid
touching the ribs. It causes far less trauma to surrounding tissue than
traditional approaches, and it dramatically reduces pain and recovery time. In
published studies of BA patients, 95-percent of women interviewed after the
procedure returned to normal daily activities within 24-hours. Quick-recovery
BA is not a “gimmick.”These specialized
techniques, which actually speed recovery and get you back to your daily
routine, kids and work, are published in our plastic surgery journals.Because these PS journals are “peer-reviewed”
and edited, they are the gold-standard in our field as being valid science.
Therefore, these are sound techniques, not marketing hype.Be sure
to see only a board certified plastic surgeon (by ABPS - The American Board of
Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic
Plastic Surgery) and or a member of ASPS (The American Society of Plastic
Surgeons). Also, ask if the PS has an
established, high volume breast augmentation practice, performing several
hundred breast augmentations each year. Be sure the PS has been in practice for a
while, about 20-years might be a good gauge.Does the PS offer all three incisions?Discuss the implant type (gel or saline), shaped "gummy bear"
or non-shaped, smooth or textured, implant pocket (over or under the muscle)
and the "quick-recovery approach."Ask to see their before and after photos if you didn’t see any on their
website.  If they are experienced, they should have several 100 breast
implant patients for you to view.  I would also recommend that your doctor
offer you the chance to talk to past patients who would be happy to discuss
their experience with you.  You need to feel comfortable, so make sure the
environment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or she
has ever published journal articles in professional peer-reviewed journals,
which they can provide you.All the best, “Dr. Joe”

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you is dictated by your
chest wall measurements.  Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look,
then the diameter of the implant should be equal to or, more ideally, smaller
than the width of your breast. The breast width is a measurement of how wide
your breast is at the base, which should be measured at the level of the
nipple. Choosing an implant that is smaller in diameter than your breast width
will avoid the "side breast" fullness that is often associated with a
more artificial appearance.  Other than that, you should choose the
implant based on volume, not on the dimensions of the implant. You should
choose a board certified plastic surgeon that you trust to help guide you in
this decision.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid
silicone (less cross-linked), if this implant should rupture, it will leak only
into the scar capsule formed around the implant but may cause some discomfort
or implant distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone
gel implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and try
on various implant sizers in front of a mirror to help you to get an idea of
how you will look following the surgery. You should also bring pictures of the
look you would like to achieve, as well as a favorite top to wear when trying
on implant sizers.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.Best of luck!

Dr. Schwartz

Richard H. Tholen, MD, FACS · Answer

Please realize that you have already done the hard work of selecting a surgeon, having a consultation, and receiving recommendations from a specialist (always see only ABPS-certified plastic surgeons, even better if they are also ASAPS members) who has had the advantage of seeing you in person.To answer specifically between the two choices given, I can give you some generalizations.First of all, 20cc difference between the two implant choices listed is LESS than 2 tablespoons volume, and probably 1mm difference in dimension, so these should be considered near-identical implants. So close that if you had one in one side, and the other in your other breast, you would almost certainly NOT be able to tell the difference.So here is the second generalization--the real question here is not between the 255cc and 275cc implants, it is between either of these and visibly larger or smaller implants, which would require at least 50-60cc. So if you are pretty confident that these give you the look you want, then either will give you the look you want. If you tried these on in a bra in your surgeon's office, then your surgeon should add about 10% to your best choice to accommodate for submuscular compression. This would automatically tend to favor the 275cc implant, therefore, unless you really liked the look of the 275cc implants, in which case I wold suggest aroung 300cc.I know you stressed "super natural" and "absolute biggest . . . a baby D," but neither of these implants in a petite woman such as you (but no photos or examination to determine what present breast volume you have), should add much more than a full bra cup size to whatever natural breast volume you "bring to the party." So if you have an A cup breast size now, you will be a big B or small C. If you have a natural B cup in present size, then adding either of these implants will take you to a C cup or maybe small D (especially if you buy your bras at Victoria's Secret, for example, where "vanity sizing" is in full use!), so your own breast size PLUS implants is what determines final size, and is why examination of photos at least are essential to providing some valuable input here.In general, most women wish they had chosen just slightly larger implants once they get past 6-12 months and the "newness" or concern of encounters where someone "may know" or comment. Remember, this is about how YOU feel and look, and not what friends, frenemies, or significant others might say or comment on.Another trick--I always ask my patients to do a thought experiment with me in the pre-op area. I tell them we have the "perfect" size implants to give them the results of their dreams, and that I brought along one size (not bra size but implant size, which is 20-30cc, or two tablespoons) BIGGER, and one size SMALLER than perfect. Then, in this hypothetical scenario, of course, I tell them the "perfect" implants suddenly are no longer available--deserted island surgery and the shark ate them, or similar flights of fancy--and we now have to choose one of the two alternatives. She must tell me what to use, either the 2 tablespoons (invisibly) bigger than perfect, or the 2 tablespoons (invisibly) smaller than perfect. Sort of the "half-full or half-empty" question. The answer helps me decide, just as it should you. Then, in the operating room, individual anatomic considerations will also provide input that helps inform the final decision, as in "very tight and firm skin and muscle coverage" might lead me to choose the 255cc, whereas loose skin and thin muscle coverage may make the 275cc implants "fit" better.To really answer, I'd want to see your pre-op photos or do an exam, as you are average in height, but quite petite and slim, so what your own breasts look like, and what your goal photographs show as your wishes, really are needed here to provide the answer you want. All things being equal, I'd go for the 275cc implants just based on the history of most patients' responses down the road. Not to mention the fact that childbearing and breast feeding will likely be in your future and these almost always deflate breasts and stretch skin, not the reverse. Thus, the larger of the two choices given would be the obvious and most common recommendation. For more information on the entire breast augmentation process, you may want to read my Comprehensive Guide to Breast Augmentation by clicking on the web reference link below. Best wishes! Dr. Tholen

Curtis Wong, MD · Answer

my patients are always told to go with the larger one.  The differences in dimensions is minuscule and the most common complaint is that they wish they went larger.  Go with the larger one so you won't have regrets, unless you're not motivated to be as large as you can be.

Roberta Gartside, MD, FACS · Answer

Your question is a good one.  First, one of the most common comments most women make after receiving breast implants is "I guess I could have gone larger".  The second is, you and your surgeon need to clearly define and understand your goals for size, shape and look.  Third, the difference in size between the two is small.  Less than an ounce or two tablespoons.   I would be more concerned if you wanted 255 and your surgeon was recommending 375.  We cannot tell you want size to choose ultimately that is a decision for you to make with your surgeon's guidance.

Tom J. Pousti, MD · Answer

Thank you for the question. 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, in bra sizers, and computer imaging)  as well as careful measurements (dimensional planning) will be critical.

Given that your surgery is coming up soon, I would suggest that you spend additional time communicating your goals/concerns directly with your plastic surgeon, preferably prior to the date 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 know words such as “natural” or "small D cup” 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.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and there is very little difference between the two implants you have mentioned so I would not worry about being too big with either size.Dr. Corbin

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Dear Ms. Atlas123,Thank you for your story and questions. Size of implant is only one of the considerations in choosing the "best" implant for you.Nothing substitutes for a personal evaluation and a face to face discussion of your options.Unfortunately without photos, a examination and measurements I can advise you in general terms, however I hope you will find them helpful.I personally believe that It is important for prospective breast augmentation patients to understand what determines the appropriate implant size, filler material , shape and implant location. The final decision(s) is a personal choice guided by the experience of your Plastic Surgeon.Your SPECFIC breast anatomy will dictate many of your choices. The breast foot print/base width on your chest will influence implant selection. Disregarding these measured dimensions will often lead to a more visable/conspicuous implant appearance.As far as size you know all bras are not equal in "cup size" measurements."Cup size"is a very crude and non standardized measurement and varies by bra manufacturers. Thus actual cup size you eventually are measured at is not as important as your body proportions as it relates to your desired breast size.My specific responses are:1)sizing:A)Realizing there are no standard bra (strap/cup) sizes, purchase several bras (full bodied and no padding) of the strap and cup size you think you want to be. B)take a measuring cup (1 oz=30cc) place rice in a nylon. Therefore 10 oz. = 300cc...C) try on various volumes of rice with some form fitting clothes.D)if implant is placed under the pectoralis muscle I usually add 10% volume to what the patient chooses.... To compensate for the muscle pressing down on the muscle and for the naturally settleing of the implant which often makes the breast appear smaller 2-3 months after surgery.2) profile of implant:A) for the same volume the higher the profile the narrower the base width.B)there is very little difference in projection between a moderate to high profile implantthus little affect on how the actual nipple will look.C) the base width of the breast should equal the base width of the implant D)thus I personally chose the profile based on the patients chest measurements, (a high profile on a wide chest may not result in the cleavage desired and conversely a low profile on a narrow chest may result in implant in the outside armarea)E)Cleavage is largely determined by your anatomy. This can be optimized by choosing the best profile implant and postoperative implant displacement excercises towards the midline of your chest.3)Shape of the implant:A) for the vast majority of cosmetic patients I recommend round implantsB) reconstructive patients shaped/form stable implants are often used.4)Placement decision of implant placement will be determined based on your anatomy, you current breast tissue, and your long term goals and benefits.The four positions are:A) Subpectoral which is completely under the muscle. B) Supra pectoral  which is above the muscle but under the breast.C) Subfascial which is under the fibrous layer that covers the muscle. D) Dual plane which is partially under the muscle and partially under the breast.Placing the implant in the subpectoral or dual plane position I believe in general has significant benefits: A) coverage of implant with muscle resulting in less palpability of implant (except in lower outer quadrant where ther is no muscle coverage)B) less long term internal scar formation(capsular contracture).5)Filler MaterialA) silicone gel feels more like breast tissue, less potential rippling, comes prefilled cannot adjust size intraoperatively and larger incisions to place compared to equal sized (non prefilled) normal saline implants.B) normal saline implants can be adjusted in size intraoperatively, if ruptures normal saline absorbs, potential increase rippling compared to silicone gel, smaller incision to place normal saline implants as compared to prefilled silicone gel implants.I suggest you collect several nude model photos of the goal breast shape you desire and schedule a follow up appointment with your chosen Plastic Surgeon. I trust you have chosen a Plastic Surgeons who is experienced and is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).My best wishes,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

I'm considering mentor moderate round 255cc or 275cc and can't choose. What are your recommendations?

Answers (9)

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