225cc vs 250cc? I can't decide & my surgery is in one week!

Question

225cc vs 250cc I can't decide & my surgery is in one week! I'm most concerned with looking too unnatural, but I also want to make sure I can tell the difference when it's all done with & I won't be sad about too small as I keep hearing people say. Now I am 112 lb 5'3" with very minimal breast tissue .. and have a smaller than avg upper rib cage frame

Andres Taleisnik, MD · Answer

You shouldn't need to make such a choice, since no patient is really able to determine which implant volume, 225 cc or 250 cc, will work the best and accomplish your goals. That's why you see a well-trained and experienced surgeon, who can guide you after in-person examination and discussion. First, the difference is so minimal that you probably couldn't even tell the difference if 225 cc were placed on one side and 250 cc on the other. Second, your surgeon may be able to insert a sizer implant during surgery to help determine which volume is most ideal for your goals and body. I do this frequently, since it's a minimal investment of time which yields great benefits in terms of patient satisfaction. Either volume is fairly conservative, and would probably be enough to create a clear difference without being overly unnatural. Good luck!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question!
  
After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.
  
Silicone will give you fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.
  
Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
  
During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.
  
We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.
  
The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
  
Best of luck!
  
Dr. Schwartz
  
Board Certified Plastic Surgeon 
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Martin Jugenburg, MD · Answer

Thank you for your email and your question. This is a question may of our patients struggle with.  Remember 25 cc is a very small amount, and will be virtually a indiscernible difference, once in.Consult with your Surgeon, and try them on.  All the best.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  Congratulations on your upcoming surgery.  The
best advice you can receive is from an in-person consultation.  The difference between 225 and 250cc is difficult to detect.  The size, profile, and shape of
the implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.

Austin Hayes, MD · Answer

Congratulations on your upcoming surgery. Unfortunately online recommendations will not be that helpful. It's important to remember that 25 cc of volume will not make a significant difference in your final size. If there are concerns, contact your surgeon for their recommendation.

Daniel Barrett, MD · Answer

Dear allqt,
I would recommend you to spend some time with your plastic surgeon to discuss these issues. This is a big decision to make and you don't want to end up with something you didn't really want.
Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Donovan Rosas, MD · Answer

A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.
With regards to your specific question, the most reliable way to achieve a "natural" look is by staying within the anatomical bounds established by your BWD. Exceeding these measures leads to greater lateral show and greater risk of the dreaded "fake" look. 25 cc will make very little difference intra-operatively. I typically recommend that patients define the upper and lower limits of what is acceptable with regards to volume. This gives me a number of choices (in between these values) with which the patient would be satisfied. I will make an intraoperative decision from among these options and I will use patient bias to guide me. Smaller in a patient concerned with subtlety and larger in a patient concerned with volume.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Robert Applebaum, MD · Answer

The difference between 225cc and 250cc is very small even with your size. With either of these implants sizes the result will likely be very visible you just have to decide if you want to be slightly larger or not. Either implant should look good with your frame.

Asaf Yalif, MD, FACS · Answer

The difference between 225 and 250 is minimal. I would voice your concerns to your plastic surgeon and see which one they think better fits your frame based on your measurements.

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