34A, wondering if 415cc is too much? (Photo)

That's great you found a surgeon you feel confident in. If you like his results and trust their judgement that's a good start.
Sizing is a tough process. I always give patients two sizing sessions to make sure we're getting that size right. Most patients do end up erring on the larger size - since most patients wish they had gone a little bigger after 3-6 months.
You do have a prominent ribcage and your breast sit a little more laterally. This can require slightly larger implants to project beyond the sternum.
Given your anatomy and stats - the 415 would likely get you into a C or maybe D cup fairly easily and might be more enhanced on your frame. Talk to your surgeon about your concerns and goals. And maybe resize when the AC is working properly...
Good luck!

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing. Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." Communication is key as you and your surgeon create your custom surgical plan.
Based upon your photos, your choices seem reasonable. If you are leaning "natural" then lean lower. The volume differentials are slight (45 ml shot glass). You will likely be pleased with either.
As always, discuss your concerns with a board certified plastic surgeon.

Hello, at our office we look at different measurements to see which implant style and size would fit you best. We also let you try the implants on. You may try a sizing technique at home using dry rice and tights. 451cc will typically end up being 2 cup sizes depending on the implant profile. Sizes of implants will look different on everybody. I'd recommend trying on the sizes and making sure you are 100% comfortable where you go.

Dear PopeMuffin,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

The time to change decision about implant size is BEFORE you have the surgery. Afterwards, if you want to make a change, then you need another surgery to do that. If you felt rushed, then make another appointment to discuss your concerns. Ask your surgeon to allow you to try on the 415cc (and other sizes) implants, so you can see exactly what each size would look like on you. Pictures or simulations are sometimes hard to judge. Once you have done that, then you will know if 415 is too big or if it will give you what you are looking for. Hope that helps. Best of luck!

What's natural? What's fake? No one knows but you. I can tell you that breast appearance won't drive you back to the operating room. What will is the feeling that your body proportions aren't right: your breasts are either too big or too little, once again a determination that only you can make. So, how do good surgeons select the right implant for their patients and avoid an unnecessary reoperation? By using either in-office sizing, using purpose built sizers - my preference, or using 3D photographic morphing technology. If your Vegas doc didn't do that, then he's just guessing.

Thank you for your question and photos. An evaluation in person would be required to properly evaluate you and make specific recommendations. That said, I agree with you that for your frame and dimensions 415 seems large. Do your research and make sure you are confident with your decision. When in doubt, consider a second opinion. Best of luck to you.

Selecting an implant is best done in person alongside a board certified plastic surgeon. With that being said, a 415cc implant is going to increase you several cup sizes. You must also consider the profile that will best match the look you are wanting. It's important that you feel comfortable and confident in your surgical plan. I encourage you to return to your surgeon's office for further discussion.

In the world of breast augmentation one rule that I follow all the time is less is more. That being said, you have a broad chest with mild pes Caranatum, and divergent nipple complexes. On your tiny frame, I would recommend starting with a smaller implant that is more moderate in order to accommodate your broad breast diameter. Additionally, it is important that the implant be placed in a total sub muscular pocket in order to prevent infero-lateral migration. Good Luck!