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Michael Law MD Aesthetic Plastic Surgery

How many cc’s? – deciding on implant volume

The actual size of a breast implant, measured in cc’s, is really not very descriptive of what a breast augmentation will look like, or what the cup size will be. The augmentation effect of any implant varies in different patients, and is relative to the preoperative size of a patient’s breast and the size and stature of the patient overall. A tall, broad-shouldered patient with small A-cup breasts may require 400cc implants to achieve a C-cup breast volume postoperatively, while a shorter patient with medium B-cup breasts may only need a 200cc implant to achieve a C-cup breast volume.

During the consultation process it is important for patients to be given the opportunity to examine a large number of sample implants to get a sense of how implants vary according to base diameter, projection and volume. Sample implants can be placed in a soft, non-padded bra to give prospective patients a sense of what their postoperative breast profile will be with a given implant volume. Breast forms (silicone gel bra inserts that are concave on their posterior surface, which fit over the breasts to simulate an augmentation) can also be used to give patients a sense of what their appearance will be with a certain number of cc’s added to their breast volume. Sample implants and breast forms placed in a non-padded bra, evaluated both without a shirt on and while wearing a form-fitting shirt, are a very useful means of helping patients to determine what implant volume is most appealing to them.

When a natural breast appearance is the goal, it is helpful in some patients to ‘try out’ different implant volumes and profiles in the operating room. Once the implant pockets have been created, sterile sizers can be placed in the implant pockets and the upper half of the O.R. table raised so that the resulting breast appearance can be assessed with the patient in an upright ‘sitting’ position (chest fully upright) while under anesthesia. These sizers are available not only for each implant size but also for each implant profile (low, low plus, moderate, moderate plus, high, extra high). Pre-filled gel sizers are used for silicone gel implant augmentations, while Inflatable sizers are used for saline implant augmentation. Sizers are especially useful in cases where the surgeon is trying to improve a preoperative breast asymmetry, and implants of different sizes and/or profiles may be the best choice.

Preoperative measurements that are made by your plastic surgeon such as breast base diameter, upper pole tissue thickness and lower pole skin stretch are of critical importance. For every patient there is a fairly specific range of implant volumes that will create a breast profile that would be considered natural-appearing. And for each patient there is an implant volume and profile at which the upper pole of the breast begins to appear unnatural. If your goal is a natural-appearing breast enhancement, make sure that the surgeon you select clearly understands your aesthetic ideal, and that you feel confident that they are committed to and capable of providing you with that kind of result.

There is, of course, a range of implant volumes and profiles for each patient that could potentially produce a plausibly natural-appearing result. While one patient may seek an augmentation that is ‘perfectly natural’, another may be interested in a result that is more on ‘the full side of natural’. Many patients do ask that the largest implant volume be selected that does not produce an unnatural fullness in the upper pole. By using sample implants and breast forms in consultation, and in some cases by using breast implant sizers during the surgery to confirm exactly what breast implant profile and volume produces the best breast appearance, patients can be provided with the closest possible approximation of their preoperative goals, and can be assured of a natural-appearing result.

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