I'm due to have Sientra silicone implants later this month, but I can't decide which size is best: 410cc or 440cc?

The
question of breast implant size is always difficult for prospective breast
augmentation patients.For this reason,
multiple approaches are utilized to make this determination
pre-operatively.These include reviewing
magazine photographs, external silicone sizer, and recently, the Vectra 3D
computer imaging system.Even
when tremendous care is taken pre-operatively to determine breast size, the
final decision needs to be made in the operating room by the surgeon.At this point, an assessment can be made
regarding how the patients’ breast tissue interacts with the breast
implant.Occasionally, obtaining a
specific size doesn’t allow the surgeon to meet the patients other aesthetic
goals.For this reason, locking into a
specific size isn’t always a good idea.Results are often better when a surgeon has the ability to make
adjustments in the operating room.It’s
also important to realize that for many patients, a 30cc difference in breast
size would be difficult to notice.In
reality, a 30cc difference is less than two tablespoons which is spread out in
three dimensions over the implant.In
your case, I think it’s important to thoroughly discuss your aesthetic goals
with your surgeon.Make sure he has the
latitude to do what’s best for you in the operating room so he can meet your
aesthetic goals.It’s important that you
have an approximate idea of the breast implant size that you’re considering,
but don’t become married to an absolute number.

This is a small amount of volume and it probably will not matter much.  However, there are formulas with picks the best type of implant and size based on your breast base width, sternal notch to nipple and nipple to the bottom crease of the breast. Your PS probably did this.  Goood luck.

You are talking about two tablespoons or a shot glass  in an implant that is fairly large.  it is a minor amount .  Decide if you would rather be minimally larger or not and pick one. I wouldn't worry about very much. you'll do well either way

Hi L,The difference you are concerned about is just under a shot-glass.  However, most women, in my practice, wish they were bigger a year later.  So, keep that in mind when you are on the fence. I would recommend you also revisit the PS's office, and have the staff help you with our final decision.  You are not alone, as this is a tough decision, and many, many patients agonize over small size differences.  I already know you are in the good hands of a board certified plastic surgeon, because Sientra limits their product to BC PS, exclusively.Since you have two weeks to go, here are some tips and tricks we use to help our patients out.  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.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). I wish you all the very best for your upcoming surgery, “Dr. Joe”

if you added 2 tablespoons of volume to your breasts right now, do you think you could see the difference?'In case you weren't sure of the answer, it is NO WAY!So,if you're worried that 410cc may be too small, choose the 440cc implants. My only concern is that since 440cc is only 2 tablespoons larger, if you are "too small" with 410cc implants, then you may still be "too small" with 440cc implants!Try on more implants in your bra and stretchy top and don't look at the sizes--just look at how your chest appears to you. Size issues are the most common reason for re-operation; this occurs more frequently than bleeding, capsular contracture, malposition, or any other "complication." So choose carefully, and call your surgeon's office for help; even if your surgeon is out of town, his staff is there to help! Best wishes! Dr. Tholen

Call your plastic surgeon's office.  There may be a nurse or someone else that can walk you through sizing again.  They can also order both sizes of implants so that you will be available to regroup with your plastic surgeon a few days before your surgery again. The size difference is very little but I always tell patients to go a little larger if they are unsure of the size goal. Either way, you should feel comfortable with your decision prior to surgery.  Your plastic surgeon should be able to guide you.  Good luck with your surgery!

Your question is an excellent one! Many patients have this concern. I believe that an important point is that 25- 30 cc is such a small difference that you can almost "not" tell the difference.If you got the 410 and a twin sister got the 440, you probably couldn't tell the difference. It sounds like a lot, but underneath the breast and muscle it is a tiny difference.Most women statistically wish they went bigger, so I might suggest the larger size. Ultimately your doctor and you will pick.You will most likely be happy with either one.Good Luck!Dr Chris Saunders 

The most common reason why women have another operation after breast augmentation surgery is because the size is not right and it is split between patients who want to go smaller and patients who want to go bigger. For the Sientra implant sizes you are talking about - these are Sientra smooth round moderate profile HSC silicone gel implants. The difference between the implant sizes you mention is only 30cc of volume, which is equivalent to a shot of espresso, pretty small. The difference in the dimensions of the implant is 4mm in width which is small but not insignificant, and 1mm in projection which is insignificant. In terms of the look - the difference may be slightly more fullness in the top of the breast. In general, I recommend that my patients choose the slightly larger size as long as it fits within the base diameter of the breast. If your surgeon is having you try the implants on, they generally look and feel just a bit smaller when they are under your own tissues after surgery.The critical question for you to ask your plastic surgeon is if the base diameter or width of the the 410cc implant is well within the base diameter or width of your breast or is it already pushing the limits and if the 440cc implant will be too wide for your breast. See if you can see one of the nurses in the office to try them on again, and if the office is willing - they can order both sizes to be available so that you can make a last minute decision on the day of surgery when you can fully discuss it with your surgeon.

Since you are discussing 410 cc and 440 cc I assume you are planning to use the Sientra smooth round moderate projection implants as opposed to a shaped implant which doesn't come in those volumes.  Thus, the effect that you can expect from a slight increase in volume like that in a round implant is perhaps slightly more fullness in the upper part of the breast.  As many of my colleagues here have already said, you are discussing a volume difference of 30 cc, which is one ounce, or essentially what is contained in a shot glass.  Therefore, we are not discussing huge swings in volume.  In my office, we typically perform a volumetric sizing exercise on all of our patients preoperatively so that they will see how these differences in volume will look on their body.  If your surgeon did that at your consultation, you should recall back to how you liked the different sizes.  Perhaps you could return to the office to see just the nurse ( since the surgeon is out of town) and she can repeat the sizing for you so you can reassure yourself.  If this is not possible, and you are still unsure, there are many sources online where you can find techniques to help estimate implant volume that you can try at home.  In general, I can say that the psychology of breast augmentation is that those patients "expect" to see a noticeable increase in their breast size and volume, and thus, they are generally more prepared and happier if we "err" on the side of a tiny little bit more volume, which 30 cc counts as, as opposed to a tiny little bit less.  This is a judgment call on the part of you and your surgeon of course, but this is how I deal with this situation in my practice.  Best of luck to you, and whatever you decide, I would be willing to bet it will be beautiful!

The difference between these two implant volumes is just a little bit over 1 tablespoon full. This is not going to even be noticeable. I would not worry about using either of the implants as long as they have been appropriately sized for you. You want your implants me within an objective range. You don't want the implant to be too wide for your natural breast base diameter.