Will I get the look I want with 300cc-325cc? Is over the muscle a bad idea for me? I want to go from B/C to full D or DD.(Photo)

Question

So the surgeon I was hoping to have perform my BA/BL (Bilateral Breast Augmentation with a Double Crescent Mastopexy) suggested that I have 300-325cc mentor memory gel implants placed OVER the muscle.... I'm currently a 36 B/C and would like to be about a full D or average DD. I'm nervous that not only the placement but the size is wrong for me. Any input? There is so much money involved in this procedure that I'd hate to not get even close to what I want. Ill post pics! Thanks!

Joe Gryskiewicz, MD, FACS · Answer

Hi LilLadies,Good luck in your new adventure!  Your ideal photos really help.  You will not even be close to your ideal size, (remember I have not examined you) with the 300-325.  The Mentor memory gel are good implants.  There are some time honored rules for going on top of the muscle which are published in our journals.  You need at least 2 cm (one inch about) of tissue in the upper part of the breast to be able to go on top of the muscle.  I doubt you would qualify.  So, I can't say for sure, but  looks like you would go under the muscle and go bigger.  Here are some tips for picking your size:  This is perhaps the hardest decision for
a patient to make, as well as the surgeon. 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.  Approximately 50 cc (1-2 oz.) is added to the final volume to account
for flattening of the implant in the partial submuscular pocket. Once you
decide on a size you like, then add on about 25-50 cc, 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. Then, the patient’s verbal requests
are factored into the analysis.Our
average size over the last 6,000 implants was 350. 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 they
have an established, high volume breast augmentation practice, performing
several hundred breast augmentations each year. 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”

Vincent N. Zubowicz, MD · Answer

From the photograph I would predict you get a good result with a breast augmentation only preferably silicone gel on top of the muscle.

Eric Desman, MD · Answer

Your questions are great and appropriate. Unfortunately, an online 
forum is not going to be much help in answering your questions.Sizing of breast 
implants is a very individualized 
process. Essentially, you need to custom fit the implants to your body. First guess is that from your picture, 325 cc is not going to get you to a DD. However, is DD good for you?
In order to properly size implants, you need measurements of several key
 
items. Regardless of what manufacturer of implant your surgeon uses, 
they all have what is called dimensional fitting systems. These systems 
basically take some measurements of your breast width, height, and 
tissue stretch to determine the optimal volume for your particular 
tissues. i.e. What can your tissues handle? That is the "science" of 
determining the optimal size implant for your tissues. The artistry with
 your surgeon comes in taking the ideal size and working with some 
judgement to get you as close as possible to your desired outcome.  So 
someone 5'4" 125 lbs with
 3 children vs. someone with no children may have different optimal 
volumes due to the differential stretch in their tissues.  You can 
Google
 "High Five Augmentation" to get a quick idea of the process.Good luck.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  Keep in mind that it is quite common to receive differing advice from different plastic surgeons; ultimately it will be your decision which plastic surgeon to have perform your procedure. Personally, I  would not offer you a sub glandular breast augmentation or the use of any type of “crescent” mastopexy.  Frankly, given that this is what has been recommended to you, I would suggest that you seek additional opinions with board-certified plastic surgeons prior to making any final decisions.
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. I have found that the use of words such as  “natural” or "full D or DD 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, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size.
 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 generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.
I hope this (and the attached link) helps.

Brooke R. Seckel, MD, FACS (retired) · Answer

Based on the photographs of the desired look that you want to achieve you may need larger implants than 300-325 cc.  The photos you show are quite large breasted with full cleavage and if they have had augmentation they may well have breast implants larger than 400-450 cc or larger.I am sure that your plastic surgeon has chosen breast implant size based on your breast base width.I suggest that you reconsult  your surgeon and undergo a breast implant sizing system whereby specially shaped implants can be placed into a non-padded bra and you can see the look that you hope to achieve.  It is much more important to focus on the look that you desire than on the specific size of the breast implant or bra size.I also have concern that a crescent lift is not going to adequately lift your breast.  Based on your photographs you may well need a breast lift with a vertical component.If you're in doubt about the advice you have received it is certainly acceptable to seek a second opinion from a different board certified plastic surgeon.For more information on combination breast augmentation with lift please read the following link:

Will I get the look I want with 300cc-325cc? Is over the muscle a bad idea for me? I want to go from B/C to full D or DD.(Photo)

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