It is very important to communicate your size goals with your surgeon. 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 “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
Downsizing implants and switching to silicone
From the photo you've provided I think you would to really well with a "modest" downsize and switching to silicone gel. I wouldn't get too hung up on the numbers as far as 339 vs. 371 cc, and that is usually a decision I make with sterile breast sizers at the time of surgery. It is important for you ton know that saline actually "looks larger" cc per cc than silicone. So your 425 cc saline augmentation may equilibrate most similarly to a silicone gel augmentation of 450/475cc.
Even if you down size slightly, I would still predict you would want to be with a 371 cc to prevent too much droopiness from the skin that may happen if you go too small. Your tissues may look somewhat droopy with a 339cc -but that is only something that can be determined at surgery.
My recommendations again are to go for a modest down sizing of the implants changing it to silicone gel. You will be so much happier with the natural feel of the implant. Using a sizer at the time of surgery is the best and most accurate way to see what size looks best for your tissues...also I would consider a "capsuloplasty" or "shrinking of the capsule" which can be helpful in down sizing procedures and not having to do a formal breast lift/mastopexy.
I hope this helps!
You Want to be Smaller? We have Options!
To go from a D to a C is achievable. Dropping 75-100 cc is an old rule of thumb to go down a cup size, so 339-371 would be in the ballpark.
Option 1. Tell your surgeon what you want to achieve and trust him/her to use intraoperative Sizers and judgement to achieve your preoperative instructions.
Option 2. Have a preoperative deflation performed, then try on the various implants and agree on a plan with your plastic surgeon. I like to empower patients with this choice if they can live without implants for a day or two. When we agree on a plan ahead of time, I am able to get patients almost exactly what they desire.
Suggestions for Breast Implant Size
It is very difficult to determine the exact size and shape of implant that will get you the results you desire without an examination by a board certified plastic surgeon. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be tough to answer your question. For example your native base width of your breast will determine in many cases the maximal volume per implant profile that you can accommodate. To illustrate a 100 cc difference may make a significant difference with a narrow base width, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors. I always find it helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. I bring these photos to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to achieve their wishes.
I personally order more than one set of implant sizes and use sterile sizers placed in the pocket during surgery to know in advance exactly which implant would work best for you. Software morphing programs can be helpful in some but not all cases (e.g. doesn't work well in my experience with existing implants, sagging or asymmetric breasts).
My advice is to accept advice from your board certified plastic surgeon after a formal consultation and examination with measurements.. If still confused don't hesitate to get a second opinion.
Implant Selection Process
Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.
Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor. The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant. It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
I would suggest going down about 50cc from your pics but would be very careful because you will likely have a Mastopexy in your future. Also, pictures and bra sizes are relatively useless which is why companies like Mentor make a very detailed sizing system which every surgeon doing breast augmentation should probably have available for their patients.
Thanks for your question. I typically tell me patients to go down 75-100cc's when I am asked that question in a circumstance similar to yours. There is no way for you to "try these implants on" since you are going down in size. I would have a frank conversation with your surgeon and see what advice they think is best for your situation.
With a revison placing smaller implants, you may need a lift. It is hard to say without an exam. Sometimes the decision is made after the exchange to see how the breasts respond.
With smaller breast implants, you will likely need a lift
Either implant will look nice on you. Discuss your goals in general terms with your plastic surgeon, and he or she can help you decide. I do think that, with downsizing, you will probably need a mastopexy (breast lift). This will require more scars, but will provide an improved shape, and will also allow correction of your minor asymmetry. If your implants are above the muscle, then you might wish to consider placing the new implants below the muscle. This will disguise the implants better, and would also probably give you a less abrupt transition from your chest to the upper aspects of your breasts.
Sometimes, if the implants are to be changed to submuscular positions, then I advise the patient to consider a two stage approach: Take out the existing implants, allow some healing time to let the breast tissues readhere to the muscles and then later place new submuscular implants. Understandably, most women don't want to be without their implants, but this does reduce the need for possible breast lift. If your implants are already below the muscle, then the breast lift will improve the upper pole contour. Discuss all of the above with your plastic surgeon.
I haven't seen what you looked like before surgery, of course, but there are some issues with the result shown here. Your implants are asymmetrical in position which might be your body or might be a capsular contracture. It also looks like if you downsize, there might need to be a lift considered to remove loose skin and level the areolas. These are almost more important to address than the size of the new implants.