I want to go from a saggy D to a full D cup. What cc implant size range should I stay within? (photos)

I've nursed 3 kids. I'm currently a 38 D but the cup is "half empty". I am undergoing a breast lift/augmentation this summer and I'm thinking somewhere around 400-425cc might be what I'm looking for to get my full D desired size . How do I know what size to start with? I'm not a true D now. Will my breasts be more like a B when lifted then add 400cc from there ? So essentially I'd be going from a B to a full D?? I don't want huge boobs. Thx.

Doctor Answers 10

Breast Lift with Implants

Hi Jet,
Yes, this is a hard decision to make.  From your photos, I think you will benefit from a lift.  I can't say for sure obviously, but yes, I think that is a good way to look at it, that you are going from a lifted B then on to a full D.  Regarding picking a size, here are some tips: This is perhaps the hardest decision for a patient to make, as well as the surgeon. Cup size estimates can be misleading, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc. You can try on implants in the office by placing them into a special bra.Approximately 50 cc (1-2 oz.) is added to the final volume to account for flattening of the implant in the partial submuscular pocket. Once you decide on a size you like, then add on about 25-50 cc, because in real life the implant will be flattened slightly by your tissues.Multiple measurements need to be taken to fit an implant to your exact anatomy. Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer. Then you and your surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan.Keep in mind larger implants tend to have more problems over the years.Since silicone implants wrinkle less than saline implants, they might be your best bet.

You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and see what you think.Implant size must square with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wall are taken (seven in total). Implant size selection has been an issue of much discussion.

Therefore, I use a wide variety of methods, but the implant size is always established preoperatively.Also, patients are advised to bring reference photos demonstrating their ideal size and shape. A photo album of patient pictures is maintained to assist them. These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery. In determining the final size selection, I always place the highest priority on the preoperative measurements and potential tissue cover. Then, the patient’s verbal requests are factored into the analysis.Our average size over the last 6,000 implants was 350.

Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). All the best, Dr. Joe

Minneapolis Plastic Surgeon
5.0 out of 5 stars 269 reviews

I want to go from a saggy D to a full D cup. What cc implant size range should I stay within?

Thank you for the question and pictures. Base on your photographs, you are a good candidate for breast lifting.   Ultimately, careful measurements (dimensional planning) will be an important part of the preoperative and intraoperative planning process. You simply will not be able to receive precise enough advice online, regarding the best type of breast lift or breast implant to achieve your personal goals. In my practice, I use an intraoperative tailor tacking technique to individualize the breast lift to the patient specific situation/anatomy and goals.    

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. 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" or "huge boobs" 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  in bra sizers and 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.  I find that the use of temporary  intraoperative sizers ( with the patient in the upright position)  allows for accurate selection of breast implant size/profile to achieve patient's goals as precisely as possible.

I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Perky D cup desires

The important thing is, you have clearly thought this out and know what you want. What you need is an in person consultation and physical exam by a board certified plastic surgeon. During your consultation, measurements will be taken and breast implants tried on for size determination +/- recommendations for a breast lift.  This takes all the guess work out of the equation. Glad to help. 

Ryan Stanton, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 117 reviews

I want to go from a saggy D to a full D cup. What cc implant size range should I stay within?

   400 cc may be reasonable.  This will depend upon the density of the breast tissue and the tightness of the breast lift.  I always help my patients with this volume decision.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

How to go from a sagging a D cup to a full D cup

Thank you for your question.  Based on your photographs you will need a breast lift with a vertical component.  This is necessary to reposition your nipple to the proper position and will involve visible scars.

All the you have adequate breast tissue you will likely need a breast implant for upper pole fullness and firmness of your breast.

Choosing the size of breast implant will require an in person examination and consultation with a board certified plastic surgeon.  You will need to undergo a breast implant sizing examination where various sized implants will be placed into a non-padded bra.  Is important to concentrate on the look that you want and not a specific cup size.  The size of your implant will of course be based on the amount of breast tissue left after your lift.  My guess is based on your preop photograph that with the amount of breast tissue that you have a 400 cc breast implant might be too large.  For more information on choosing breast implant size please read the following link:

Ideal Results After Augmentation Mastopexy


I have a number of comments that I hope will be helpful for you to obtain a happy outcome.  You speak of bra sizing as though it is a reproducible, standard of measurement.  It is not.  Bra sizes are very variable from brand to brand, and from model to model.  Similarly, how a breast changes in size and shape is not predictable with any given implant size, so how it might fit in any given bra after surgery is not predictable.  So, as we say time and again, no surgeon can guarantee a result in cup size. It is better to think about proportion as a means of communicating results. Two better methods of communication would be using sizers in the office, or bringing in goal photos of women in clothing, full or near full body shots.

Your breasts are large and ptotic (sagging).  Your goal pictures are of very tight and high breasts that have a high proportion of implant volume contributing to their final breast volume.  No matter how tight the breast lift, you would need an extraordinary large implant to replicate their ratio of breast volume to implant volume.  Therefore, you should consider a reduction, lift and implant, which can be performed as a single operation.  This would reduce your breast tissue and allow a larger implant to be used without dramatically enlarging your breasts beyond your goal.  It might seem illogical but it is not; nor am I suggesting that implants are 'better' than your own breast tissue either.  But if you are really trying to achieve the results you posted, it would be the only way, as I have just previously detailed.

Augmentation mastopexy and 'augmentation reduction-mastopexy' are actually almost identical operations from a technical standpoint.  They are complex and require a high level of skill and experience. Please seek out surgeons reputed for complex cosmetic breast surgery.  Certification by the ABPS and membership with the ASAPS are minimal but important credentials.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

I want to go from a saggy D to a full D cup. What cc implant size range should I stay within? (photos)

Breasts sag because there is a discrepancy between your skin envelope and your breast core. A woman with a droopy "DD" cup , should expect " D" or a full "C" cup with lift only. Usuallay, a breast lift  will make you lose a cup size. However, looking at your pictures, you will need a vertical mastopexy to get you the lift and projection you desire.
A consultation in person is important where careful measurements are taken and a proper decision is made whether implants are needed or not.

Maan Kattash, MD, FRCS, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 53 reviews

Breast lift and implant

The photos that you provided as your desired result are not realistically what you can expect to achieve in terms of scars or final breast shape.  You need to look through before and after galleries and find patients that started off with breasts like yours and see their final results.   You will likely need an anchor type lift and an implant in the same operation, to give you the upper pole fullness that you are looking for based on your desired results. However, adding an implant will increase your breast size by a cup or two. Obtain an in person consultation with a plastic surgeon with experience in simultaneous breast lifts and implants as this is the only way to obtain accurate advice.   Best of luck.

Luis H. Macias, MD, FACS
Los Angeles Plastic Surgeon
4.9 out of 5 stars 58 reviews

Breast lifts and augmentations

The goal photo person you show did not need a lift so it is an entirely different situation in terms of scars and also in terms of tissue elasticity. For sure you can get a very nice improvement from your starting point with a lift and implants (I'd suggest doing them separated by 4 months), but the result will not be the same as your goal photos. Better to look up folks whose starting point looks like yours and go from there.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

I want to go from a saggy D to a full D cup. What cc implant size range should I stay within?

Thanks for your question. The desired result are not comparable to your present situation. Both pictures shown of your desired results are straight forward breast augmentations and not of a breast lift. That said, I definitely feel that you will benefit greatly from the lift and the addition of abreast implant.

I would suggest a smooth, silicone gel, moderate plus profile in the range of 375-425cc located in a submuscular position. I feel that this will give the results you are seeking.n This will require a traditional "anchor type" incision. Be realistic in your expectations and you should have great results.

Search for a surgeon certified by the American Board of Plastic Surgery with years of experience. Look at many, many before and after photos. Make sure that the photos that you are shown belong to patients of the surgeon that you are considering, not his/her partner or the clinic. Given the opportunity to view countless before and after photos will give you a very good idea to the consistency of the work. Are you being shown a few good results? The situation is analogous to the baseball player who hits a home run once in a while as opposed to the player who has a high batting average because he is consistent every time he steps up to bat.

You need to be able to speak with the surgeon's previous patients. There is nothing like a one to one sharing of info. RealSelf has done a wonderful job in allowing dialogue among patients.

Next, is the surgeon an individual who can earn your trust? Trust is key. You want to be guided along your journey by someone whom you trust. Trust is earned by being candid and truthful. It should not be easily given to the title of MD.

How many years has he/she been performing cosmetic breast surgery? Do you want an experienced surgeon or one that has had limited experience?

How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.

How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications. Research, research and then research some more.

I wish you the best on your journey. I hope that the info provided has been helpful. Should you require any further clarification, do not hesitate to contact our institute. I answer all questions personally, not through patient coordinators or other marketing individuals. Good Luck

Jose Perez-Gurri, MD, FACS
Miami Plastic Surgeon
4.9 out of 5 stars 232 reviews

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.