What size & type of implants are right for me?

Question

I'm 5'10" and 140 pounds. I'm currently a small 34A. I've had two children and breast fed both of them. I'm very lean (16-17% bodyfat) and workout a lot. Is subglandular or submuscular better for someone like me? I've decided that I would prefer silicone implants. What size implant would you recommend? I would like to be a "full C" but open to suggestions. But I don't want to look disproportionate. I'm not sure of the difference between medium profile and high profile. How does this affect the end result?

Jerome Edelstein, MD · Answer

I use a technique called dimensional breast augmentation which involves taking in a number of factors and measurements, so each patient is unique.  That being said, given your height, weight, and your activity level, along with the fact you are considering a lift, I would say you are probably not that far off in choosing an implant in that range.  Best thing to do is to see a qualified plastic surgeon that has good breast expertise.

Gary M. Horndeski, MD · Answer

At size 34 A each 100 cc’s of implant corresponds to 1 cup
size change.  To achieve a full C would
require 200 cc implants.  I always
recommend small round textured silicone gel implants placed retro-pectoral
since they look and feel more natural, are more stable, less likely to ripple
or have complications needing revision. 
Implant profile is irrelevant in the retro-pectoral position since the
muscle compresses it.  Unfortunately, you
have not provided any photographs but you give a history of two pregnancies so
it is possible that your breast has drooped. 
If that is the situation, I recommend a new technique called Breast
Augmentation with Mini Ultimate Breast LiftTM.  Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage.  Through the same incision, implants can be
placed.  Aligning the areola, breast
tissue and implant over the bony prominence of the chest wall maximizes
anterior projection with a minimal size implant.  22% of women who undergo breast augmentation
alone require revision within 2 years because they are dissatisfied with the
result. Best Wishes,Gary Horndeski, M.D.

Michael Law, MD · Answer

I would suggest under the muscle breast implants As far as size, this is a decision you and your surgeon will make together. It is important to understand that there is not a wide range of implant sizes and profiles that will look natural in each individual patient. Given your height, weight and preoperative breast profile, there really is a limited range of implants sizes and profiles that will produce a full - but natural - breast appearance. So it is important to establish from the beginning whether or not you and the surgeon that you have selected have the same aesthetic vision. One of the best ways to do this is by reviewing the surgeon's 'before and after' photos.You can certainly purchase the size bra (unpadded) that you would like to fill out and experiment at home with bags of rice. One implant manufacturer also has a 'pre-consultation' kit with sample 'sizers' that you can use at home to get some idea of the implant size range that may work best for you. You could bring some photos to the consultation appointment of breasts that are appealing to you, and you can show your surgeon which of their 'before and after' photos are most appealing to you. There is no substitute, however, for the process of examining different implant sizes and profiles with your surgeon during your physician consultation appointment. You can hold them up in front of your breasts, and you can put them in an unpadded bra that is the size you would like to be. Your surgeon can show you how each implant's base diameter and projection will impact breast appearance. This will give you a very good idea of the result you are likely to get from each size and style.Implant 'profile' refers to how wide an implant is (base diameter) compared to how much forward projection it has (height). The implant manufacturers use different terms to describe these profiles, but in essence there are three types: low profile (wide base diameter / modest projection), intermediate profile (less wide, more projecting) and high profile (even narrower diameter, very projecting). If the goal is a full but natural-appearing breast enhancement, almost all patients need a low- or intermediate-profile implant. A 'deflated' appearing breast with little forward projection usually looks best with a intermediate profile implant, while a more youthful-appearing breast with some natural, inherent projection often looks best with a low profile implant - especially in a slender patient with an athletic frame. There are very few patients that need a high profile implant, at least not if the goal of surgery is a natural-appearing breast enhancement. The combination of narrow base diameter and high projection is really an implant style that is more suited to breast reconstruction than breast augmentation.

C. Bob Basu, MD, MPH, FACS · Answer

I consider two factors when selecting implants for my patients:1. Dimensional planning2. Gel Implant Sizing systemDimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look. Hope this helps.Best wishes,Dr. Basu

Steven M. Camp, MD · Answer

Thanks for sharing your question.  With breast augmentation the preoperative planning including implant selection is very important.  There are many factors that help a surgeon determine appropriate implant size including the patient anatomy, breast tissue thickness, desired look and lifestyle.  An in person consult with a board certified plastic surgeon is important to determine these variables.  Also, different profile implants are used in certain situations.  Consult with a board certified plastic surgeon in your area to help determine what is best for you.Best of Luck

Jaime Campos Leon, MD · Answer

Thank you for the question.To best help you, a physical 
examination or picture evaluation is required in order to determine 
which procedures and techniques would be best for your case.Dr. Campos

Tom J. Pousti, MD · Answer

Thank you for the questions. Despite your good description of your body type and goals, online consultants will not be of specific enough help to you. Generally speaking, I prefer the use of the sub muscular (dual plane) positioning of breast implants for the vast majority of patients seeking breast augmentation surgery.   I think that the outcomes associated with this positioning tend to be better long-term and associated with fewer downsides. Also, 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're 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. I have found that the use of words such as  “natural” or “full C 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.
 The use of computer imaging technology may also be very helpful during this communication process.

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.
I hope this (and the attached link) help.

Lee E. Corbett, MD · Answer

Your questions are all very good ones and will be easily answered when you have your consultation. You can see the implants, try on the sizes and your chosen surgeon will be able to help you sort out your choices so that you can find the one that is best for you.

Jonathan Weiler, MD · Answer

I agree with the other panelists, you really need to visit with a BC PS to discuss your options, there are lots of factors that come into play and there is no one size fits all. Bring pictures of what you would like your breast to look like in terms of size to your consultation and make sure your Dr explains all the options to you. Good luck

Robert Singer, MD · Answer

The best cosmetic result in any
particular breast augmentation patient depends on a variety of factors,
including: your individual anatomy, 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, breast dimensions 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.

Keep in mind that following the
advice from a surgeon on this or any other website who proposes to tell you
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
you find a plastic surgeon 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

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