Breast lift and implants soon with 250 cc mentor silicone under the muscle. I am quite confused regarding the size. (photo)

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. 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 difficult to make this determination. For example, the existing 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 breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size 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). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.#breastaugmentation#findingtherightsize#BA

Dear Ms. Nikitata, Thank you for your question and photos. Sorry for your confusion.Based on your photos and not being abel to examine you or take measurements I believe  and agree that you will need both a mastopexy (lift) and augmentation.If you just have a breast augmentation you may have the "snoopy dog" appearance:When/if breast mound is in the correct position on your chest the resultant effect is that the nipple areolar complex (NAC) auto rotates down (like a waterfall). Resulting in a odd shaped breast and the NAC pointing downward. You have several choices to consider.My responses:BREAST LIFT1) the reason the breast sags is that the "skin covering" is proportional larger than the breast tissue.2) the majority of your breast tissue is below where the breast mound should anatomically be located.3)if you refill the volume only(breast implant)... the nipple areolar complex (NAC) will rotate over the top of the implant like a "waterfall" resulting in a full breast mound but unfortunately a downward rotation and location of the NAC.4)the only method known to create a aesthestically acceptable breast will require trading incisions/scars on the breast for a pleasing contour and relocating the NAC.5)depending on your desires (shape and size) the scar may vary from:A) just around the nipple (doughnut)B) to a added vertical incision (lollipop)C) to include a horizontal incsion in the breast crease (anchor)6)while breast incisions/scars are required....there are ways to modulate/improve the appearance of the scarring process.BREAST AUGMENTATION 1)size: Bra manufactures unfortunately have not standardized their bras...therefore cup sizes (A,B,C, etc.) are rough measurements. Breast implants are filled by cc.'swhich is much more accurate. So purchase several full bodied non padded bras and place rice (1 oz. = 30 cc) in a nylon and try on with some form fitted clothing. 2)types of fillers:A) silicone gelB) normal saline (newest variation on this is the Ideal breast implant)3)shaped vs non shaped4)projection vs base width (high to low)5)placement of the implantA)under the the muscleB)above the the muscleC)combination: dual plane.Recommendation:1) Bring several nude ideal/model photos of what you want your breasts to look like 2) write out your SPECFIC questions.3) make a follow up appt. with your selected Plastic Surgeon who I trust who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).My best wishes,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

Thank you for the question and pictures. Ultimately, you will do well spending additional time with your plastic surgeon communicating your goals, questions, and concerns. In other words, careful measurements, dimensional planning, and careful communication will be key.

Generally speaking, patients undergoing this combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. As you know, breast lifting involves some removal of breast skin envelope; there may be limits as to how large of a breast implant can be utilized safely.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
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 or D cup" etc 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. The use of computer imaging may be very helpful during this communication phase.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.I hope this, and the attached link, helps. Best wishes.