One doctor suggested 500cc to 670cc. Another said 350cc is my max and that 400cc will look too big. Who should I trust?

Question

My BWD is 15.5. Another doctor told me that they will not be able to fit 450cc into the pocket behind my muscle, and his assistant told me to wear a push up bra after the procedure.

Roger Tsai, MD · Answer

Great question!  Without understanding your goals and desired look, it is hard to assess what implant is best for you.  Depending on what type of implant profile you desire (for example, moderate or high) will alter the cc size of the implant.  Also make sure your doctor is measuring your base width and that you are not doing it yourself as there is a particular way to do it - as 15.5cm is is on the very large end of the scale.  IF 15.5cm is true and accurate then you can really go as high as you want.Although these are just general observations, only with an in-person consultation can an accurate recommendation be provided.  Best of luck and hope this information helps!- Dr. Roger Tsai   @DrRogerTsai

Urmen Desai, MD, MPH, FACS · Answer

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Gerald Minniti, MD, FACS · Answer

Hello,There are other and frankly more important measurements relating to  implant sizing (biodimensional analysis) then BWD, unfortunately some of my colleagues and most potential patients are not aware of that.  Nipple to inframammary fold under stretch has a much greater impact on determining anatomic capacity than BWD, and women with a wide breast but a short distance from nipple to fold are very limited with implant size. Based on safety alone and not knowing anything else, I'd go with the doctor recommending the smaller implant. However, be sure he is ABPS certified/ASAPS member surgeon.  Best of luck!

William Bruno, MD · Answer

The final volume of your breast implant depends on a variety of factors (skin quality, breast tissue elasticity, rib cage, width, etc). Your tissues will only stretch so much, which can only truly be determined during surgery and assisted with the use of sizers. It's difficult to tell you how many cc's your torso can accommodate by only knowing you base width. An exam in person, or a photo at the least, is needed to make any meaningful recommendations.Best wishes,Dr.Bruno

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

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  350-670cc is a wide range of implant sizes.   It would be helpful if you could also include photographs.  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

Steve Laverson, MD, FACS · Answer

The answer is:  TRUST YOURSELF.  You should have had the opportunity to try implant sizes in the mirror and select for yourself.  I cannot imagine a woman delegating the choice of her implants to someone who will not be wearing them.  Would you willingly allow someone else to choose a dress or shoes that you’ll be wearing continuously for years?

Daniel Barrett, MD · Answer

Dear Hyemomof3,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

Martin Jugenburg, MD · Answer

It is difficult to say without assessing you in person. I suggest seeking a board certified plastic surgeon for a consultation.

Daniel Kolder, MD · Answer

The addition of 3D imaging to your breast augmentation consultation will take the guesswork out of deciding on the perfect breast implant size for you. With this technology, you can visualize exactly how different implant sizes will look on your body and from there make a much more informed decision about the option that's going to help you meet your goals.

One doctor suggested 500cc to 670cc. Another said 350cc is my max and that 400cc will look too big. Who should I trust?

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