Under Muscle Gel Implants. High or Moderate Profile? 400cc or 450cc?

My only concern is size&profile. I am 36years old, breastfed 2 kids, lost volume on my breasts. Have some sagging but my nipple is still over crease. I weigh 130pounds and am very fit and toned. I am 5"4" and my breast size is a 34 Bcup. When I was breast-feeding I was a 34 Dcup. Before my kids I was a 34C cup. I want to be a D cup.

Doctor Answers 31

How to pick shape and size of breast implants.

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1) This is the most common type of question on RealSelf.

2) It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.

3) Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.

4) Then your surgeon has to tell you if your chosen look is realistic for your anatomy. The most common mistake is to go too big.

5) I recommend that the surgeon NOT make a final implant choice in advance, because this is just an educated guess.

6) The surgeon should have a large inventory of different size and shape implants available in the operating room.

7) Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.

8) Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating roon inventory, and put in your breasts to complete the operation

Manhattan Plastic Surgeon

Implant size

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I think it will take 450cc minimum to get you to a D cup. Profile depends on how wide your breast is. Once you decide on volume, you want the widest implant that will be totally covered by your natural breast. Your surgeon should be able to tell you which profile is best. 

Some patients do not understand profiles, and mistakenly believe a high profile will give more fullness superiorly. Not true. A high profile has a smaller diameter for the same volume than a moderate profile does. If you have a wide base to your breast, you may need a moderate profile. If your breast is not as wide, then moderate plus or high profile may be needed.

Again, your surgeon should help  you with this.

Good luck.

Re: Under Muscle Gel Implants. High or Moderate Profile? 400cc or 450cc?

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Since you have a small amount of glandular ptosis, I'd first recommend a dual plane augmentation to fill out the inferior pole and rotate the nipple areola slightly upwards. That way, you're not just filling, but lifting a little as well. 

In terms of your desire to have D cup breasts, I'd bring both sizes into the operating room and see what looks best. Based on your photo and body measurements, 450cc in a moderate plus profile seems reasonably appropriate.

I hope this helps - good luck with whatever decision you make!

Breast Implant Sizing

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Hi Ms. Bolton-

Great question...and one I see quite often here on RealSelf. Unfortunately, as I have said before, sizing of breast implants are an individualized decision. A decision that can only be reached by a team of EXPERTS : You and your Board Certified Surgeon. You, because you know your body, your wants and desires (cup size, etc) and your surgeon, because he or she will get to know you, your wants and desires as well as your anatomy and they will know the implants styles and technical specifics. For a surgeon to take you out of the equation and say they will give you the result they know will make you happiest is short-sighted.

I have recently implemented new 3 Dimensional technology (that I am sure other surgeons will have a negative opinion on because it is new and they don't have it) for a couple of reasons. First, so that each individual patient has the ability to see what their post-augmentation results MAY look like (they can switch between sizes....you can see the small difference between a 400 and a 450cc implant as well as what effects different projections (High Profile, Moderate Profile Plus and Moderate Profile) will have on your final results. And Second, it has allowed me added time to more efficiently talk to patients about sizing....the 4th Dimension, time! Patients have really been excited about the exercise of seeing their results before surgery and I like spending the time with them. 

I hope this helps...my recommendation would be based on your anatomy and my measurements of your breast/chest...but I think you would be very happy with Moderate Profile PLUS 450cc implants; they will fill out the skin envelope and volumetric needs, enhance the upper and lower breast poles and may even elevate your NAC (nipple areolar complex) a touch.

I hope this helps!

Good luck....

Dr. C


John Philip Connors III, MD, FACS
Atlanta Plastic Surgeon

Match the implant shape to your chest

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with the advent of different profiles of implants patients and their doctors can better match the implant to the patient's anatomy and desires. There are no hard and fast rules.  In general the larger the implant the greater the diameter.  The ultimate diameter should fit the patients chest wall and existing breast mound.  This decision is best made between you and your surgeon.

Randy Proffitt, MD
Mobile Plastic Surgeon

Size, profile, and implant volume

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In order to increase two cup sizes, you will need a high profile implant and a silicone gel-filled implant is probably a good choice because of the lack of muscle coverage over the lateral side and underside of a breast that is borderline sagging. The implant will not lift the breast but it will look lifted because it is filled out, particularly the lower pole of the breast. However, with a relatively sagging and flat breast it will become very projected with a high profile implant and this doesn't look as natural as it looked in the past even though the volume is increased. A better choice might be a middle profile implant which would increase the breast size by 1 1/2 cups to a C/D size. 

The volume of the implant is determined by measuring the width of your breast in the upright position with arms down and subtracting 3/4 to 1 cm. This would be the diameter of the implant and would be looked up under high profile gel-filled implants (Mentor or Allergan). Whatever volume this is will fit, look good, and increase your size by about 2 cup sizes. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Not possible to answer your question responsibly

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Hi there-

While I would love to be able to give you the confidence you would gain from having surgeons in this community recommend an implant for you, it is VERY important to your future happiness that you understand that without a formal consultation and examination, it is simply not responsible for me to try.

The appropriate choice of an implant for any individual patient depends on not only her goals and her history (children, breast feeding, etc.), but also (and most importantly) on measurements of skin quality, quantity, and chest/breast dimensions.

My personal belief is that because this decision is so complex, and because fundamentally what you are hoping to achieve is a particular appearance (and not a particular implant), it is a mistake to commit to an implant before surgery.

Visit with a Board Certified Plastic Surgeon for a consultation- discuss your goals with them, and then trust them to guide you in the process.

Breast implant sizing

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 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.

Moderate plus profile versus high profile implants

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It is difficult to give a definitive answer from the information you have provided.  I personally prefer the look of the Moderate Plus profile implants placed submuscular. They have a larger base diameter than the high profile and give fullness throughout the entire breast.  I would recommend consulting with a Board Certified plastic surgeon in order to chose a size.  You should be able to try on the various sizes to ensure you are happy with the look.

Kindest regards,

Neil J. Zemmel

Need to have a plastic surgeon help you to decide

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Without seeing you in person, it would be impossible from just looking at your pictures whether I would recommend submuscular or subglandular, high profile or low profile, and whether you should go with 400 or 450 cc.  They might all work fine, or one method might be preferred over another.  I recommend that you make an appointment with a board certified plastic surgeon in your neighborhood and make the decisions based on his/her recommendations. 

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.