Size of Implants, Areola Incision, High or Moderate? (photo)

Included b&a pic of DESIRED results & my own pics/measurements My doctor uses Allergan silicone & suggested high profile 600-650cc but the rice test seemed large with 375cc He seems to prefer Areola incision but I desire to breast feed in the future He doesn't use sizers, but my left breast is smaller, esp noticeable during rice test Under bust: 28.5" Bust: 33 Waist: 25 Hips: 34 Distance b/t nipples: 9 Distance-center of ribs across breast to side: 6 Areola diameter: 1

Doctor Answers 17

600-650 cc implants and periareolar incisions

I don't like to say this or say it very often in a forum like this, but with over thirty years of experience, I can tell you that you are a set-up for disaster if someone attempts to put a 600-650 cc implant behind your breast. It is not feasible or reasonable to think that one can choose any implant size and make it work or achieve whatever size/shape the patient thinks they want in one procedure. The maximum size increase without stretching, distorting, and risking revision-requiring complications is two cup sizes. This is achieved with a high profile implant (saline-filled or gel-filled) that is the diameter of the internal width of your breast. My guess based on your pictures and chest circumference would be that it would be the 375 cc's you mentioned. 

I would also condemn the rice test and any external sizers. They don't help proper sizing and are often quite misleading. The implant needs to match the internal width of your breast and there are three forward profile volumes available for that width (actually four in saline-filled). That's how to size an implant properly. The rest is getting it positioned properly behind the pectoralis muscle and breast and getting it healed there. 

Another mistake today is the use of periareolar incisions. The best incision both short term and long term has turned out to be the inframammary crease incision which allows the best positioning and adjustment of the pec muscle without cutting through the breast and exposing the implant to skin bacteria in the ducts which is probably the major cause of capsule contracture. It is also best for the long term for replacement, size change, or other revisions. 

I would agree with Dr. Rand's response and get another plastic surgeon's opinion. 

Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Implant Size Selection

Thank you for your question and photos. A 600c implant seems very large for you ! Based on the information you have provided, I agree that a 350-400cc implant would most likely achieve the result you are looking for. You should discuss your concerns with your surgeon before proceeding. Good luck.

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
4.9 out of 5 stars 70 reviews

Implant Sizing

I concur with the other physicians in that 600+ implants will likely be too large for your frame and the aesthetic goals as implied by your photos.  I think there is a role for sizers, especially during surgery, but the most important factor is limiting the implant diameter to the width of your breast.  In addition, I think recent evidence suggests the benefit of the inframammary incision in reducing capsular contracture rates and, hopefully, maintaining your ability to breastfeed in the future.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 81 reviews

Determining implants

Hello. The most important factors for determining the size of implants that could be used on a patient include width of the base of the breast, the size of your thorax and the amount of breast tissue and skin you have. 600 cc implants are extremely large implants in my opinion and you seem to have a small frame. I would also speak to your surgeon about the approach he will take as I would not recommend a periareolar augmentation.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 75 reviews

Choosing implant size

I think high profile implants may be a good choice to achieve the results you want but I think 600-650 may be too large. I highly recomment the use of sizers to achieve the results you want.

John Squires, MD
Denver Plastic Surgeon
4.9 out of 5 stars 79 reviews

Implant choices

If you did the rice test and you thought it was too big then don't go with such large implants.  Inframammary will preserve more tissue than the periareola approach, but I like both incision approaches.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Implant Sizing


I concur with the others that the rice knows more than your surgeon!  You'll be very close to your goal photos with 375 cc.  

I would like to throw just a few thoughts your way for you to consider:

1. Breast augmentation is ideally a surgery that will provide you a pretty, long term result that will last for many years without the need of a surgical revision.  Please consider this when choosing sizes.  I would hope that you go to a surgeon that uses dimensional planning (something we can't do for you on line).  This technique really nails down the most appropriate implant for you based on your anatomy, and minimizes the potential for post operative complications that may lead to an unplanned revision surgery.  Choosing an implant larger than this is ok, but increases your risk the farther you deviate.

2. High profile implants are the rage with both patients and surgeons.  To be sure, there are many people who are very happy with them. However, high profile implants have the highest risk of early reoperation, as well as late reoperation. This is because their shape concentrates their mass force into a smaller area (hence the reason why HP implants are used on smaller women).  Unfortunately, this causes more significant, deleterious changes to your breast tissue over time, as well as immediate unplanned problems like double bubble and implant malposition in the upward direction.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Desired implant size

You have a small frame and look to be a 32A.  The picture you desired will be best achieved with a 400 to 450 HP silicone size.  The photo looks like a 32D.  There is a easy way to determine size.  Measure your chest below the breast which you say is a 28.5" which would make you a 32 cup size.  Then place Mentor implant sizers which are form fitted over your breast into a soft bra.  Then you measure the fullest part of your breast with the sizers in place.  If the measurement is 34" then you are a C, if the measurements is 35" then you are a D cup.  Somewhere in between is C-D.  600-650 will be at least a DD or larger. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 92 reviews

What size implant

I would stay with the rice test. I think that a 650 cc implant is way too large. without your height and weight as well guiding me, I would think that a 375 range would be good. I also do not like HP implants. I feel they do not look as natural as mod plus style implants. You may want to get a second opinion. Also you can go online and look for women who have about the same breast volume as you, and you like their result. that should list the implant chosen which should help you.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 reviews

Size of Implants, Areola Incision, High or Moderate?

I concur with other surgeons who feel that a 600-650 cc implant will get you to a size considerably larger than your goal, and that an implant that large will have an unnatural appearance even if it met your size objective. 

I too use Keller funnels, and I am quite doubtful that an implant that large can fit through an areola of your size without damage to the implant or tearing of the skin. I generally prefer breast fold incisions for most patients, but I wouldn't even  try to insert so large in implant via the areola in you. 

Sizers and rice tests are quite useful in picking implant size, and my recommendation would be in the 350 to 400 cc range. 

I think another in person opinion is in your interest. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.