Is there much difference between 350cc and 400cc over muscle, mod implants? I’m 126lbs, 5ft 7.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Thank you for your question. It sounds like you are a fairly thin person who doesn't have much breast tissue. I understand you would like to have as much volume as possible from your procedure, however, I'd like to warn you about having large implants placed over the muscle. Unfortunately, most PS will not discuss the risks, complications and maintenance associated with larger implants. Be aware that breasts implants are heavy and when placed on top of the muscle, they tend to descend and cause irreversible skin damage (sagging), chronic pain, nipple numbness, etc. So, please consider a smaller implant to minimize the extent of damage and possible breast implant revision to re-position the implants in the future. You can see/read about these in the breast augmentation revision forum on this site. I believe patients should be well informed before committing to a procedure that has a 30% revision rate. Do your research. This site is a good start!  I hope this helps.

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look. I would not struggle over a 50 cc differential as this will ultimately represent a subtle change (slightly more than a shot glass). Most patients would have difficulty discerning such a small difference which would amount to mere millimeters of width/projection.As always, discuss your concerns with your board certified plastic surgeon (ABPS).

Hi Ann158,
Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.

Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.

Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

There is no significant difference with the two sizes. Usually, surgeons would advise you to choose the smaller size which can give you the same results with a larger one. The appearance of an implant would depend on an individual, even with the same size. This is because each individual has a different chest measurements, so it would be hard to tell which implant size is best for you without an in-person examination.

Hello and thank you for your question, Topics to discuss with your surgeon are type of implant
(gel vs. saline), location of incision (peri-areolar, inframammary crease,
arm-pit) and location of the implant (above or under the muscle).
In term of implant type, saline or gel implants,
each have their own advantages and disadvantages. Ask your surgeon to
discuss these with you. Choosing the implant should be a shared decision
between you and your surgeon. As far as the implant shape, round
implants can result in great aesthetic outcome and are used in the
vast majority of patients.
Placing the implant under the muscle results in a smoother and
more natural upper pole slope. Placing the implant above the muscle, paticularly
in thin-skin individuals can have the downside of visible rippling and looking
"fake".
Regarding the implant size, many factors including patient's desired
breast size, skin envelope (both quality and quantity) and breast width
diameter among others are important in selecting the implant size. In
a typical consultation, you try a variety of in-bra sizers and in combination
with several other measurements that your surgeon will do, the final implant
volume is selected. I hope this helps. My best,Shain A. Cuber, MD

My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
One question that might be helpful for you to consider: would you be more disappointed if you are slightly too big or slightly too small after the breast augmentation procedure?
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.
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 look” 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 helps. Best wishes for an outcome that you will be very pleased with.