450 cc or 500 cc silicone implants? (Photo)

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, 450 or 500cc would likely accomplish your goals.  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.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

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

There are number of ways surgeons will try to convey a sense of post augmentation size in the pre-operative period. These include 3D imaging and sizers. While helpful, they are not perfect.
The use of sizers can help give a sense of volume increase when placed in a bra. However, placement underneath tissue will alter the shape. While there is no exact way in which to quantify this shape change, patients should be aware that there is a change in projection when placing an implant underneath the muscle which is difficult to predict. I have heard a number of theories ranging from a % drop in projection to a purported volume drop. These are not scientific correlates with no consistency. I have not found these to be helpful.
Patients should be aware that how they appear in a garment is not exactly how they will appear post operatively. 3D imaging is helpful in accounting for this variation. Ultimately, at the end of the day, this remains a computer simulation.
Ultimately, even if submuscular placement did account for a perceived volume loss, 25-50 cc is a subtle change and equates to the volume of a shot glass (at most). 
Implant selection is a process which should involve both the physician and the patient, using good communication to take full advantage of patient goals and surgeon's experience. The best advice is to remain within the parameters as defined by your unique anatomy (BWD).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Thank you for your question.  In my practice, to help my patients choosing the correct size, I ask them to come in and try our special sizers for a very accurate "final look".  Patients bring a sport's bra of the size they want to go up to.  In your situation, I would try an added 150cc versus added 200cc and you could decide while looking in a mirror.  I like to be personally present when discussing size in breast augmentation.I always recommend at least 100cc difference when changing size.  FYI, 150cc is 10 tablespons and 200cc is 13 tablespoons... so the difference between your 2 wishes is only 3 tablespoons.Hope this helps!Kind regards,Dr. Marc DuPere,

Dear amp902Thank you for your question and photo!  A size increase of 100 cc will make a nice change.  The size of the implant - should be relative in proportion to your breast shape.With Warm RegardsTrevor M Born MD

Once you have an implant in place, most patients need to go up at least 150cc to really see a change.  Without measuring you it is hard to say what will work the best, but cheating up to a 500cc HP device ( if your surgeon, not a nurse, feels that it will fit in your frame dimensions) may be the best option.  However, it is simply a myth that going underneath muscle causes a volume loss.  Most women underneath the muscle are only partial submuscular these days, and that means that the muscle in no way should constrict or mask the implant volume at all.  I hope this helps.

Hi amp902,

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, MD, MHA, MS

Certified, American Board of Plastic Surgery 

Member, Am. Society of Plastic Surgery

Hello and thanks so much for your photo and question. Please re-discuss size with your surgeon. You will not be able to notice the difference when only considering 50cc's . Sometimes when a patient is debating between such a little amount and they are okay with the larger size, we will encourage them to go slightly larger (only slightly), depending on the look you're going for. Having said that, you must remember that the larger the implant, the greater the possibility of complication. Please stay reasonable.All the best!!

Thank you for your question. I agree with converting to high profile implants. However in reference to implant size, I would recommend you consider converting to implants which contain a more cohesive silicone. These implants provide much more upper breast volume and fullness at all times due to the more form stable silicone properties of these implants. These are called Smooth Cohesive Full (SCF) implants which are made by Allergan. This would allow you to achieve the look you desire in the 450 cc range without having to jump all the way up into the 500cc range which may be too large for your petite frame. My patients have absolutely loved this newest style of silicone implants. Discuss this with your surgeon. Best of luck!

I think that the volume you see in a bra may falsely give you a bit of extra volume or projection because they do not sit right on top of your chest.