I think size is a very difficult thing to give advice on. For my own patients, I find it helps to bring in 'wish pictures' of women preferably without a shirt or bra on. Although this isn't perfect, it does take away words like cup size (which is tricky for a number of reasons, not the least of which is it differs from store to store) and 'little bit'. The lift itself is going to remove some skin which will make you a bit smaller just by itself. Definitely recommend an in-person consultation about size with your surgeon. I would not typically have such a range available in the OR. Good luck!

Published on Jul 11, 2012

A range of 200 to 425 cc seems like a rather broad range to me. I usually have sizers within, say, 50 to 75 cc of one another when I am considering revision surgery of a patient, particularly one I have not operated on before. Since you appear to know the volume of your implants, it seems a little over cautious, perhaps on the part of the surgeon to order so many size choices.

I rarely put implants smaller than 300cc in patients except very petite patients, as I feel that certainly anything under 250cc is a very modest improvement. How much smaller did you want to go? We use surgical simulation software in our office to help take this kind of guesswork out, as we can subtract the old implant volume from the simulation and add back new implant styles into the model to better visualize with our patients. VERY informative and helpful in decision-making for patient and surgeon alike! - Dr. Sayed

Published on Jul 11, 2012

There is a fairly significant size difference between 200cc and 425cc. It is hard to say which size is ideal without an in-person evaluation. The implant size will also depend on whether or not your surgeon is removing breast tissue as well. I would think 200cc is too small and maybe you would go with a size in the low 300cc's. I would strongly encourage another meeting with your surgeon before surgery so you can go over the sizing again and work towards a range that is a little closer. It is very important both you and your doctor are very clear on your goals before hand.

Published on Jul 11, 2012

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 this. As you know, it will be important 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.

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 good size” 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.

Tom Pousti MD
www.PoustiPlasticSurgery.com
619-466-8851

Published on Jul 11, 2012

Typically, sizers are inflatable and filled with either saline or air temporarily during surgery to estimate the best implant size to choose. Both saline and air can appear larger than silicone. Therefore, your plastic surgeon is likely anticipating that difference with a range of sizers available starting with 200cc which translates to a silicone implant of around 300cc, or the lower end of the range that you are considering especially with your planned "downsizing".

Published on Jul 11, 2012

Yes, there is a big difference. Every 120-150cc is about one cup size so that will give you an idea. Good luck!

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery
Newport Beach, San Francisco,Miami, Italy, Anguilla
949.640-6324/1.888.234-5080(Ca)
FAX- 949.640-7347
Website: http://www.surgery-plastic.com
Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)
Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors
Plastic Surgery- 2005-2017
President,American Society of Bariatric Plastic Surgeons
www.ASBPS.org
Organoderm Skin care/ScaRxTape

Published on Jul 11, 2012

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.

With regards to your specific question, your desired implant choice range is fairly wide (200-425cc). There are a number of options available in that range with the polar opposites yielding very different results. I would recommend try to narrow that range somewhat as you approach surgery. Any options that will be available at the time of surgery should acceptable to you in order to ensure a satisfactory result.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Published on Jul 11, 2012