What's the best profile for a Sloped Rib Cage Measuring 13.5 for BEST cleavage with nipples centered? (photos)

Thanks for including photos with your question. You will get a great result from breast augmentation; you have an accurate understanding of your anatomy and how that may make it harder to achieve your wish pic cleavage. Because the implant will be placed so that the nipples are centered over the most projecting part, and because your breast/chest wall anatomy is making it point laterally, the implant may not give  your wish picture cleavage without a bra - and yet look beautiful. In a bra, you will be closer to that wish pic. Profile, size and type of implant can only be chosen after an in-person examination with measurements, etc. All the very best to you. 

I would recommend a smooth, round, high profile implant that is tailored to your soft tissue dynamics.I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable.  Additionally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).
Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon 

Thank you for your question and photos. Based on your photos, you are a great candidate for sub muscular breast augmentation with silicone implants. You do have some rib cage asymmetry with the left side higher than the right. An in person consultation and examination is required to determine your best option. I use the Vectra 3D to simulate postop results using different size and projection implants to see which would give you the best result. See a board certified plastic surgeon for an in person consultation/evaluation. Good luck.

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implant
#toobig #breastimplant

Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. You are correct in that your anatomic starting point will to some degree determine how much space will be present between your breasts after breast augmentation surgery.  Other factors involved include careful breast implant pocket dissection and careful selection of breast implant size/profile.   If your chest wall slopes laterally, care must be taken (during breast implant pocket dissection) to avoid postoperative breast displacement problems. Remember (when it comes to breast implant pocket dissection and achievement of ideal breast implant cleavage) that each nipple/areola complex must be centered on each breast mound. It is not unusual for us to use different sizes of breast implants to improve breast symmetry as much as possible.
Ultimately, careful selection of plastic surgeon and 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.
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 words such as “natural” or "C or 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 sizing concerns) helps. Best wishes for an outcome that you will be very pleased with. 

 Hello and thanks for your question! 
  I believe that communication with your plastic surgeon is very important to achieve the results you desire. You have expressed that the cleavage is more important to you then projection and it is critical that your surgeon understand this. To achieve this I would use appropriately sized round implants  and focus on developing the pocket as close to the midline as is safely possible.  this will give you the most cleavage without disrupting the thin skin overlying the sternum.  Also since your concern is the cleavage rather than implant projection, it may be more desirable to select a moderate profile implant instead of a high profile implant.
 Picking a surgeon who has the experience and artistry to perform these maneuvers and has good aesthetic outcomes is probably the most important decision you will make  with regards to your surgery. 
 I hope that this has helped you and if you have further questions please do not hesitate to contact our office. 

 Sincerely, 

 Dr. LAKSHMAN. 

From your photos, it appears that you have a very normal and natural breast shape.  While your nipples and areolas sit a little lateral, more so on the left, they are by no means outside the norm of what we usually see.  
One of the best ways to determine a breast implant shape, size and projection is to allow you to chose it.  That way there is no quessing as to what YOU want!  With the gummy bear implants that we are using today, this is done by first measuring your chest wall to see what size implant would work in terms of dimensions, especially the implant diameter.  After that, what we do at our office is to allow you to try on implants in a bra so you can decide what size range you like.  From there we can chose an implant that has the right diameter at the base and the right projection to give you the size you are looking for.  The shaped gummy bear implants produce a very natural looking breast that also feel very natural.
This method works out very well and patients are very happy without having to get confused by all of the information about sizing that is here on the internet!
Sientra gummy bear implants work very well above the muscle which allows for better positioning of the implants for patients who have breasts that are set quite wide apart.  This allows us to get your breasts to look closer together so that you can have some cleavage.
I have added a web reference and a video that should be of some helps for you.  There is also information about 24 hour rapid recovery breast augmentation on the website that you may want to consider as well.
I hope that helps.
Best regards.

Thank you for the question, this is one we are faced with frequently. Prior to undergoing any procedure it is incumbent on the patient to have realistic expectations regarding what can and cannot be accomplished for them. Not all patients can have tight cleavage without a bra. Your model in the wish photo has that cleavage with a bra, I doubt it is anywhere near that tight out of the bra. You are going to get an excellent result with breast augmentation as long as you choose a talented and experienced surgeon and understand he will do his best to maximize your cleavage within the scope of the limitations placed by your anatomy. Size, shape and style of implants can only be chosen after a full consultation and examination. 

You are indeed a good candidate for a breast augmentation, but understand that plastic surgeons must work under the constraints of your anatomy that cannot be changed...the width of your breast, the shape of your ribcage, the position of your nipples (more laterally placed nipples cannot be moved without leaving behind unsatisfactory scars), and your skin/tissue tightness vs. pliability. Selecting the proper implant width in light of the implant size and the amount of upper pole fullness you desire is key. Also, textured implants may be useful in holding their position better, as smooth implants may tend to slide laterally in patients with ribcages that slope to the sides. Keeping the nipples centered on the implant and yet obtaining "cleavage" can be difficult when the nipples are laterally placed, as that might lead to using too wide an implant that would extend too far laterally under your arm. Again, you can obtain a very nice result from augmentation, but need to be aware of the issues and constraints for which there is no magic answer and that may call for your expectations to be reasonable. 

I see in your photos all the potential for an excellent result, very much like your wish photo. The key to get there is to use a moderate profile implant to avoid an unnatural bulgy upper pole and to get the creases level and especially to use the correct diameter implant so they will be close enough to give nice cleavage. Please check my web site for example photos.