Sizing doubts - should I go smaller or bigger?

Question

I’m getting Mentor CPG321 implants and unsure about sizing. Due to my breast assymmetry, droopiness and light tissue on top, my surgeon’s two options: 280/315 or 315/355, but recommended the smaller pair. I’m now size 30C or 32B depending on bra. CM from collar bone to nipple: left: 17.5 cm; right: 16cm. Circumference (including boobs) 83cm. Waist 68CM. Distance between nipples: 20cm 166CM, 56KG. Very active (yoga, backpacking, weights) Should I go smaller or bigger?

Donovan Rosas, MD · Answer

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.
I typically discourage patients from stressing over small volume differentials (45 ml is equivalent to a shot glass) as it is unlikely to make or break a result.
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. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Brian K. Reedy, MD · Answer

Thanks for your question!
Reach out to your surgeon and try on implants again. Hopefully this will help you decide which look you prefer. In my experience, patients wished they had gone larger. Best wishes!

Chet Mays, MD · Answer

Thank you for your inquiry!   Size is a decision you have to make yourself.  We would love to meet with you to discuss your options.  Schedule a consultation with a Board Certified Plastic Surgeon.

Daniel Barrett, MD · Answer

Dear mwl1708,
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

Gary M. Horndeski, MD · Answer

At size 32, each 100 cc of implant corresponds to 1 cup size change. From this, you can determine the size needed to achieve your desired result. You may need a simultaneous lift. I would need photographs to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style 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 size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Connie Hiers, MD, FACS · Answer

I would suggest trying on both sizes and see which you prefer. Both sound reasonable for you. If you do lots of upper body lifting, or long-distance running, then go smaller.

Camille Cash, MD · Answer

The difference in volume between the implants you are considering will be barely noticeable once in the body.  Your surgeon has had the opportunity to exam you and speak with you about your goals.  If she/he recommends a certain set of implants and you trust your surgeon I would strongly consider their suggestion.  You can also return to your surgeon's office to "try on" the implants to get a feel for how you may look after surgery.

Timothy P. Bruce, MD · Answer

In my opinion, I like to use a patient's anatomic sizing, personal desires, and wish photos to pick implants together. Spending this time with your surgeon helps everyone get on the same page regarding goals and desires. I counsel patients to not worry TOO much about relatively small differences in implant volume (around 50cc) as this difference can be very subtle once all healing is complete.

Pawel Szychta, MD, PhD, DSc · Answer

Go with the smaller implants (280/315) if you want a natural, proportionate look that fits your active lifestyle and reduces strain on your tissues, especially given your asymmetry and light upper breast tissue. Larger implants (315/355) will give a fuller look but may feel heavier and could pose more risks over time. Trust your surgeon’s advice and try sizers or imaging to help visualize the result. Smaller is often the safer choice for long-term satisfaction.

Sizing doubts - should I go smaller or bigger?

Answers (12)

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