Surgery is in 2 Weeks and Still Unsure of the Implant Size.

I'm 38 years old Asian female. 5'7" tall, 124 lbs with small frame. According to my PS. By measurment, my breasts are sagging yet from the looking at them. They are not at all. After trying on few implants. First pick was 375cc but in the final, I'm going with 400cc saline high profile. My PS is going to fill it upto 430cc to eliminate any possible wrinkle on the skin when bending down. I'm little concern. I don't want to look top heavy or breats to appear fake?

Doctor Answers 7

Implant Selection Process

In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  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.
Dr. Gill

Houston Plastic Surgeon
4.8 out of 5 stars 86 reviews

Breast implant sizing

 The more breast surgery I do the more I realize that there is no correlation between the size of implant and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saiine/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, 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" or "top heavy" 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 breast 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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Unsure of breast implant size, avoid fake and top heavy look

I would consider trying on sizers again or getting sotware imaging done to get the result that you want. 

Breast implants come in different volumes and profiles, so make sure that you talk to your plastic surgeon about your personal measurements, and what profile fits your body the best.  You want to be confident before you have surgery in choosing the right breast implant volume, type, and profile.  You're still probably going to be nervous about having surgery, but eliminating as much uncertainty as possible will help you recover faster.


Roy Kim, MD
San Francisco Plastic Surgeon
4.2 out of 5 stars 6 reviews

My surgery is in two weeks and I'm still unsure about the implant size.

To give you a valid answer we need more information. I make my size recommendation to patients based on the measurement of their chest and breast dimensions. The thickness and elasticity of the skin is very important. A picture would have been of some help. Your BMI is 19.4. I am guessing you don't have a lot of fat under your skin. The. We also don't know the size of your breast now. In general for a patient like yourself, the larger you go the more artificial you look.

Farhad Rafizadeh, MD
Morristown Plastic Surgeon
4.9 out of 5 stars 47 reviews

Consider Imaging

This is a difficult question to answer without photos or an exam. However, there are a few questions that I have that you might discuss with your surgeon:

1. If you are worried about rippling, why saline and not silicone? Overfilled saline implants can be firm. Rippling is certainly less with silicone implants

2. Are you going above or below the muscle? Below the muscle decreases rippling, and can give a more natural look.

3. I have found "trying on" implants relatively inaccurate. I think one of the computer imaging systems gives the surgeon and patient a better idea of what you want to look like.

4. Finally, if concerned, get another opinion! You need to be comfortable with the decision.

Hope this helps!

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 94 reviews

Breast augmentation and implant size selection

You are asking very good questions and it is very important that you feel comfortable with your decision and your plastic surgeons advise in selecting an implant.  Even though you provide us with information, each person is so unique, it is impossible to give you advise through this type of forum.  The best thing for you to do is get one or two more opinions by seeking additional consultations from other plastic surgeons.

Albert Dabbah, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 11 reviews

Doesn't want breast implants to look fake

I think the best approach in choosing implant size is to try on sizers as apparently you have done.  Althought not perfect, it gives you the best idea of what an implant volume added to your current breast volume will look like in terms of eventual breast mound size.  I am a little concerned that the implant volume planned (430cc) is 55cc larger than the one you chose.  Saline high profile implants are a little rounder and more prominent in contour, which in some patients are the right match, but in others, particularly if they are slender patients with thinner tissue, can look more obviously "implanted" or "fake" than do silicone gel implants or lower profile implants.  On the other hand, for larger sized implants in patients with narrower breasts and chest walls, high profile implants are needed.

If you are concerned, I think you can find some photos in magazines of breasts that you like, and also, just as importantly, examples of breasts that you don't like because they look "top heavy" or "fake", and although the surgeon can't match these photos, it will help you communicate with him or her what your aesthetic ideals and goals are, and may help you avoid a result with which you may be unhappy.

You mention that your plastic surgeon told you that by measurement, your breasts are sagging.  Perhaps the larger sized implants are meant to fill out a larger, looser skin envelope.  However, one must be careful with this.  If a patient's breasts are sagging enough to need a breast lift, but instead larger and larger implants are placed in order to fill out the loose breast, and to avoid the additional scars of a lift, oftentimes the breast still sags and the larger implants cause even more breast sagging and tissue stretching over time.  This issue needs to be discussed with your surgeon so that you can be sure that your breast is not a sagging breast that really needs a lift as well.

Robert M. Grenley, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 87 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.