Will 425cc be too big for me? (photos)

Question

Hi i am 42 with 3 kids, i am due to have a augmentation in 2 weeks time. However i was told i need to have round 425cc over the muscle inplants. I am afraid these will look large. I want to remain quite natural. Please could someone advise me. I am so confused as to cancel it or go ahead. These are the 3D images of before amd after tjat was taken at the clinic

Stephen T. Greenberg, MD, FACS · Answer

Hi there, thank you for your question. We recommend under the muscle implants for a natural look. Size of an implant is based on multiple factors, depending on the cup size you are looking to obtain will determine what implant size would be best for you.

Kenneth Hughes, MD · Answer

At your next pre-op visit, try on a profile bra with various 425 cc sizers under a tailored blouse, tight sweater, swimsuit, workout clothes, and other garments you typically wear so that you have the best idea of whether the garments fit as desired with the implant selected. Submuscular placement affords placement of smooth implants, less long term rippling, greater camouflage, and probably a reduction in tissue thinning over time. Most patients with small breasts are better served by a submuscular augmentation to permit a more natural breast and better camouflage for the implant. The compression factor you reference is generally associated with under rather than over the muscle placement, not dual plane. Very few breast augmentation patients have enough breast tissue to permit a subglandular augmentation. Slightly decreased projection may be noted following submuscular placement, but no actual loss of volume.

I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy. Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision.

I would recommend that you go with the size that boosts your self-esteem, and fits your anatomy.  Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision.

Robert Cohen, MD · Answer

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Daniel Barrett, MD · Answer

Dear Tirnanog77,
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

Donovan Rosas, MD · Answer

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
Another point which is often under appreciated is that of anatomy and starting point. Any implant will add volume to the volume which is already present. The implant is additive. A particular volume will not necessarily confer the same cup size to different patients (often times it will not even confer the same cup size to different breasts in the same individual...remember they are "sisters" not "twins"). 
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.The key to obtaining a natural result is to stay within the parameters defined by your BWD. 
With regards to your specific question, "too big" is relative. As long as you have been accurately sized according to your unique BWD, you should be fine. Of greater concern is the degree of ptosis/sagging your photos demonstrate. Implants will not lift. I would consider a lift in conjunction with a submuscular augmentation. An "over" approach is only preferred when there is sagging which will not be addressed via lift...however, this is rarely the first choice of operative plan.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
  
Determining the “perfect” breast size before a planned breast augmentation is quite a difficult task. Each individual has a different concept of “normal” breast size. In addition, there is no standardization of bra size in the manufacturing industry. One company’s “C” is another company’s “D”.
  
There are various ways to determine desired breast size. Bringing in “wish pix” to demonstrate to your surgeon will make him / her aware of your anticipated goals.  Placing an implant in a bra gives an extremely rough idea of anticipated breast size. One may estimate volume by adding rice to a baggie ( 1 cc  1 ml) and adding the volume to your breast beneath a bra. Some surgeons offer computer imaging. 
  
The most important measurement is the base width of the implant. If you drop a vertical line from the medial most and lateral most aspects of the breast, and measure the distance between them, this suggests a base width. If an implant is too narrow, you will not have adequate cleavage. If wider than the base width, you will have excessive cleavage and “lateral boob”.  The fill of the implant then determines the amount of forward projection. I recommend you visit an implant website (e.g. Mentor, Allergan, etc.) as they will list base widths, fill options, and projections for each implant size they offer. 
  
I recommend a thorough discussion with your plastic surgeon to ensure that you are both on the same page.
  
Best wishes…

Tom J. Pousti, MD · Answer

I would be concerned, based on the limited photographs, that you will not do well with your current plan. Based on your photographs, it seems that you will be best off undergoing breast augmentation as well as breast lifting surgery. Also, make sure that you learn about the pros/cons associated with breast implants placed in the sub muscular versus sub glandular position.  If in doubt, best to postpone surgery and possibly seek additional consultations with well experienced board-certified plastic surgeons who can demonstrate lots of experience achieving the types of outcomes you would be pleased with. Generally speaking, the best online advice I can give to ladies who are considering breast augmentation 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. Sometimes, it is necessary to seek several consultations before you feel comfortable about your choice.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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 may mean different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size. The use of computer imaging may be very helpful during the communication process. The use of in bra sizers may also be helpful. In other words, use as many “visual aids” as possible during the communication process. I encourage patients to meet with me as my times as necessary, to feel comfortable that we are both on the “same page”.
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. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.
 
I hope this helps. Best wishes for an outcome that you will be very pleased with.

Mahmood Kara, MD - Account Suspended · Answer

Hello. Thank you for your inquiry. It is important to have an in-person assessment regarding your concerns as it is difficult to determine virtually.

Exact end results and cup sizes are usually quite difficult to calculate as everyone has a different starting point.

There are many different factors that go into choosing a breast implant size which will correspond with your body dimensions while concurrently achieving your aesthetic results. Some of these factors are: Implant size (CC's), Implant profile (Low, Moderate, High), Placement of the implant (Subglandular vs. Dual Plane) etc. We utilize smooth round cohesive silicone gel 'gummy bear' implants for the best results.

During a consultation your aesthetic goals are heard and taken into account with the measurements of your breasts and the integrity of your tissue, as well as level of ptosis (sag). From here we collectively can find your 'perfect fit'. You are able to try out sizers and different implants in our office such that you can get an idea of what size you would be post-operation. We also offer Crisalix 3D plastic surgery virtual simulator during our in-person and virtual consultations to preview potential results. After your consultation, you will receive your very own implant sizers to take home with you (at a small cost) whether or not you decide to go forward with your procedure.

I usually recommend that my patients stop smoking, take vitamin C daily, and avoid aspirin/ibuprofen and vitamin E 3 weeks prior to surgery. I specialize in the 24-hour Recovery method which minimizes trauma to the breast and decreases pain post-operatively.

We encourage you to look at our website and Instagram (drkaraplasticsurgery) for lots of before and after pictures!
Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery.

We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!

M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind
Hello. Thank you for your inquiry and congratulations on your surgery! It is important to have an in-person medical assessment regarding this issue as it is difficult to determine virtually. Continue to update your doctor in the matter and follow their post-op protocol.

Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery. We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!

M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind