480 or 520 silicone implants? (Photo)

Question

Help! I can't decide between 520cc and 480cc silicone HP under muscle. I am 30, 5'8-9, very active, slim frame and 36 C w/moderate breast fat. It's hard to choose based on sizers because I am told they will look smaller under muscle. Also hard to tell what I want based on photos of other women. Some look too projecting and top-heavy with 520s and others look large but quite socially acceptable and lovely. Goal is slightly larger than photo listed. I just don't want to scare my mother in law.

Gerald Minniti, MD, FACS · Answer

Hello,
It is not up to you to decide the actual implant volume to use based on the result of in office sizing; that is what your surgeon should do. In general, there is a need to use a larger implant then what was used to size you, and your surgeon should know that if he uses this excellent method.  If you trust him to operate on you, then you should trust him to determine actual implant volume necessary to achieve the results that you liked while sizing. Best of luck!

Dallas Buchanan, MD · Answer

Thank you for your questions. I do not see any attached photos. That being said, keep in mind you are being worried about a difference of only 40 cc, which is less than a 10% volume of the entire implant so this is a very small difference. You need to make sure that rather than the size, the implant width fits your breast dimensions well. If both implants will fit, then ask yourself which scenario makes you more worried, at three months feeling like you went too big, or feeling like you went too small. If being too small is most worrisome, then go with the larger implant, if being too big is more scary, go with the smaller implant. I think that whichever you choose, you will likely be happy. Hope this helps!

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.  The choice between 480 and 520cc will depend on your individual breast measurements.  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.  FACS
Harvard-trained plastic surgeon

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. This will ensure that you avoid the dreaded "fake" look. 
With regards to your specific question, the volume differential you are considering is small (40 cc) and is nearly equivalent to a shot glass. While sizers are not 100% accurate an there will be a difference in shape post op, the volume is fairly consistent and the clothed appearance will be close.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear kid30aj,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

Paul C. Dillon, MD · Answer

To choose an implant consider the following suggestions: 
Make sure that preoperative pictures are provided and/or your choice is made after seeing a Plastic Surgeon. Consider the fact that most people regret not going bigger (if there are regrets at all) Make sure you know whether or not you are okay with the implants being wide and touching your arms when you walk. Try some sample implants in the Physician's office.  Try an implant that is "too large" and one that is just right.  Usually I find that somewhere in between is a good post operative fit. Consider the fact that on side profile if your nipple is at the bra line (without a bra on) you may need a lift. 
These are just a few suggestions that I use personally.  Physician's vary in the preoperative assessment but I hope this helps. 
 
Dr. Dillon

Tom J. Pousti, MD · Answer

My best advice: more communication.

It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
It's
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.

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. For example, 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 him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

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, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with (by the way, don't let your "mother-in-law concerns"  influence your decision-making too much).

Mahmood Kara, MD - Account Suspended · Answer

Hello. Thank you for your inquiry.
You may be an excellent candidate for breast augmentation surgery. Exact end results and cup sizes are usually quite difficult to calculate as everyone has a different starting point.
It is important to have an in-person assessment regarding your concerns as it is difficult to determine virtually.
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

Brian Windle, MD (retired) · Answer

Your question is  very frequent one as well as one that many patients fret over.  There are a couple of things to keep in mind.  First, the difference you are worried about is just under 3 tablespoons.  You would not notice any difference between these sizes.  A very accurate way to get an idea of what an implant would look like trial implants in a tight sports bra.  Sizing is very difficult now since some surgeons use the standard smooth round silicone implant that we have used for many years while others use the natural feeling gummy bear textured implants with a very flat back to their shape.  With these implants we measure your breast width and then chose an implant that matched that width.  We then change the projection to get the shape or breast projection that you want.  This seems to give far superior results that women are very happy with after their surgery. The gummy bear implants also have a reduced complication rate.  The texturing reduces the capsule contracture rate and allows placement above the muscle to reduce the problem of animation.You should spend time with your surgeon to make sure you are getting the size you want.  I have added a video and web  reference for you.  I hope that helps.Best regards.

Ronald V. DeMars, MD (Retired) · Answer

Choosing the right implant for a patient requires a full consultation and examination as well as viewing their goal photos of other patients that have the postop look they want coupled with years of experience doing the procedure. That is your surgeon's job. If the surgeon is making you choose the implant, I would suggest finding another surgeon. Sticking implants into your bra in no way shows what they really look like inside you, it is quite different. Even the new computerized 3D machines give only a vague idea and that is based on how the computer was programmed as they definitely cannot look into the future to know what your contours will be. With their current level of sophistication they are little more than a sales gimmick.The surgeon should be making these decisions during surgery with the use of internal sizers.

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