What size is a 200cc, 300cc, 350cc, 400cc, 500cc, 600cc, breast implant?

measuring for breast implant size

Patients interested in breast implants often get locked in on the implant size instead of the actual breast cup size they desire. Since the beginning of breast implants, prospective breast augmentation patients attempt to research what they want by researching the implant size by cc volume instead of their pre-operative measurements. It’s easy to get mesmerized by cc volume as compared to a friend who already has breast implants, or by the array of breast augmentation photos across the internet.  What those photos often don’t include are the pre-operative measurements including true bra and cup size, the diameter measurement of the implanted breast implant, and the projection measurement.

Comparing apples to oranges is a huge mistake when researching breast implant sizes. To begin, most ladies are wearing the wrong sized bra. Ladies have been wrongly taught for decades how to properly measure for the best fitting bra. The biggest mistake is measuring ON-TOP of the breasts instead of just below the breast. That measurement gives you your accurate diameter. The cup size follow, but ladies need to understand that cups are not the exact same size from 32, 34, 36, 38, etc. measurements. A 34-D cup is not the same D cup size for a 32 or 36.  If you doubt this revelation, then we challenge you to go to a department store to compare a 34 D to a 36 D.  The 36-D cup is actually the same cup size as a 34-DD.  That’s why when you have shopped for a 32-B bra in the past, couldn’t find your size but the sales associate offers up a 34-A instead.  It’s never a good idea to wear a larger diameter bra according to what fits your cup because you will not benefit from that bra and its actual purpose: support. If your bra doesn’t fit you snugly around your chest, you just might be wearing the wrong size bra.

Now that we’ve explored the different bra cups, that means that a D-cup for 32-D, 34-D, 36-D, etc. are ALL DIFFERENT CUPS. Therefore, a C or D cup on you is not likely to translate as the same for all those pictures scattered across the web claiming a certain volume size implant is a D-cup result. The truth couldn’t be further from this fiction.

For instance, take a lady who was a true 32-A bra size prior to breast augmentation surgery.  This patient desired to be a small D. To achieve this result, the implant chosen was a 400cc saline implant.  Years later, this same patient decided she wanted to go bigger. To increase her bra size from a D to a DD, the implant size had to be increased at least 100cc to achieve this result. The actual volume ended up being 540.  This example brings us to another eye-roll in this industry: parsing implant sizes by 10 or 20cc thinking it will make a difference. Do not argue with your plastic surgeon over this little of a difference thinking it will actually make a size difference. It won’t.  All that means is that implants are available in these minor differences.

We’ve witnessed patients argue over implants sizes between 325 or 330.  Insert eye-roll here. There is so little difference between these two implants. They would amount to the same cup size. To change cup sizes, the implant volume would need to increase usually by 100cc. The larger the implant, the larger the increase is needed for a larger cup size.

Now let’s explore the hundreds of implant sizes available. Yes, I said hundreds. Why so many sizes? Because not everyone has the same size breasts, same size chests, and same goals according to desired cup size. Implants are chosen by your plastic surgeon first by a measurement made of your breast WIDTH. Implants come in diameter widths, projection profiles, and volumes. For example, say a patient is a 32-A pre-operatively. This patient desires to be a full c-cup. This patient’s breast measurement is 12cm. For 12cm, there are five different implants profiles to choose from with Natrelle brand silicone gel smooth round breast implants.  These profiles are Low Profile, Low-Plus Profile, Moderate Profile, Full Profile, and Extra Full Profile.  With a 12cm measurement, the five different volumes that match that diameter are 230cc for Low-Profile which would be a B-cup result, 250cc for Low-Plus Profile also a B-cup result, 310cc for moderate profile, which may be a small C-cup, 365cc for the more common chosen Full-Profile which would be a C-cup, then 445cc for the Extra-Full Profile implant that would be more of a small D-cup.  However, for a patient with a larger beginning chest diameter measurement, these implant examples would be completely different to achieve the desired result. The purpose of this example to help describe the process of implant sizing according to the patient’s chest measurement. No one wants implants too narrow or too wide for their body. The implant chosen for you should be chosen according to your chest measurement, then choose the appropriate volume and projection to achieve your goal. Breast augmentation patients should not get hung-up on a particular implant size according to someone else on the web. A 500cc implant may be a full D cup for one patient, but for a patient with a larger chest diameter it may only be a C cup.  A 300cc implant may be a B cup for one patient, but for another patient who may have started with some breast tissue prior to surgery and different diameter it may equate as a C cup for them. It may also be two completely different diameters and projections.

What do I do to see if I want to be a B-cup, C-cup, or D-cup?

A B-cup? You can’t be serious. In my 20 years of managing a plastic surgery practice, no patient really wanted a B-cup. What they describe and show pictures of are usually C or D cups. The best advice I can give to help you decide what size you want to be would be to go to TJ Maxx and buy some bras that are one and two cup sizes larger than what you currently are. Such as, if you are a 34-B, then buy a 34-C and 34-D bra.  Next, go home and fill some plastic zip-lock baggies with uncooked rice. Fill four baggies until they fill the cups of the bras you purchased. You are likely going to need to fill them more or less until they fill out the cups with the bras on. Stuff the bras, put on a shirt and take some selfies in the mirror to compare the two different sizes.

Also in my 20 years of working in plastic surgery, the number one “regret” breast augmentation patients have is they wish they had gone bigger. Almost all breast augmentation patients initially think a C-cup is “big” or “huge.”  The truth is, most patients choose to be a D-cup.

Article by:

Pamela Howard

Patient Coordinator, Assistant, & Office Manager
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The Saline Breast Implant Rippling Correction

Saline breast implants were added to the armamentarium of plastic surgeons in 1968.  It would take years and the removal of the first-generation silicone implants from the market in 1992 for the technology of the saline filled prosthesis to become a viable alternative.

The thickness of the silastic shell was the first problem along with the unnatural feel and the audible “swoosh” reported by women.  Eventually, a reliable shell was developed and overfilling of the implants became commonplace to improve the palpable rippling that tends to occur over time due to an evaporation-like effect of the saline solution.  This loss of volume causes the shell to collapse thus creating the rippling and is very common.  Saline breast implant rippling is often observed around thinner areas of the breast.

The problem with rippling was never corrected and continues to occur with virtually all saline implants as they age.  Rippling in saline breast implants is the most common cause for replacing implants for correction.

Today, much more technologically advance silicone breast implants are available with a more natural feel and with improved ability to maintain their shape once placed in the body.  These implants come in a variety of anatomical shapes, and projections with at least three different stabilities. The stabilities refer to the implants ability to maintain their breast-like shape in the body.  The most “form-stable” made by Allergan’s Natrelle is called the “gummy bear” implant whose feel has been likened to a soft gummy bear candy.

Once a breast implant has resided in its pocket, usually beneath the pectoralis chest muscle for at least six months, the pocket becomes stable and rarely changes over its lifetime unless a capsular contracture occurs (<5%).  The loss of saline volume and rippling effect often gives the breast a saggy appearance but doesn’t always indicate the need for a breast lift procedure in conjunction with implant replacement.  In most cases, implant replacement with the gummy bear implant can fill-up the implant pocket and lift the breast back to a more desirable shape.

The painful part of the first breast augmentation usually results from the creation of space where there previously was none.  In a word, making the initial sub-muscular pocket at surgery hurts when filled with a breast implant.  Fortunately, once the pocket is made and is satisfactory in shape, taking an implant out and replacing it with a new silicone variety requires very little investment in pain.  In fact, it is such an easy recovery that we have called it a “Tylenol recovery.”

What you need to know before you go for your Breast Augmentation Consultation

My wife wrote an exceptional article regarding the breast augmentation consultation. Thought I would share . . . . .

The Plastic Truth by Pamela Howard

Choose your surgeon wisely

Choosing a surgeon who is Board Certified by the American Board of Plastic Surgery should be your first requirement.  A recent survey conducted by RealSelf.com found that patient satisfaction is 30% higher when patients chose a Real Board Certified Plastic Surgeon.  If you need more information about how to find a Real Board Certified Plastic Surgeon, read my article, or go to www.surgery.org.  Most surgeons will recommend you see at least three different surgeons before making a final decision. Some factors to think about when choosing the Plastic Surgeon:

How long have they been in practice?

Do they have before and after photos for you to view?

Is the office staff friendly?

Where is the procedure performed?

Does the surgeon spend adequate time with you?

Will the surgeon be seeing you for your post-operative care?

Know your correct current bra size

Most women are not…

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What’s New in Breast Implants? by Paul S. Howard, MD, FACS

Silicone Breast Implants Birmingham AL

Silicone Breast Implants

Since the silicone breast implant debacle in 1992, there have been few, if any, breast implant improvements.  In fact, due to the “silicone scare” and the unwarranted decision by then FDA Director, David Kessler, to remove silicone implants from the market, there has been the predilection of Plastic Surgeons to use saline-filled implants exclusively and live with the inherit problems exclusive to saline implants; spontaneous deflation, loss of volume over time, rippling and the tendency to feel “fake,” especially if placed sub-mammary.  The U.S. with our reactionary FDA fueled by the trial lawyer feeding frenzy that exists only in America left us decades behind in research and development for silicone implants.  The only remaining companies that were not bankrupt during the feeding frenzy ended up being Mentor® and Allergan®, both of whom managed to develop new silicone implant products.  Enter Sientra® in March 2012 utilizing years of clinical research outside of the restrictive FDA regulations to develop what seems to be a true breakthrough in silicone breast implants.   Sientra® has unveiled its high strength, highly cohesive silicone gel implant which has become known as the “gummy bear” implant.  Now fully vetted and approved by the FDA, these ultra-natural feeling breast implants have become the favorite of our patients and Plastic Surgeons in general.  Naturally they have the same profile of possible complications inherit in breast implants except they probably never deflate.  Surgeons like me are pleased with the way they feel immediately upon placement.  They do require an ample infra-mammary incision and should be placed sub-muscular as their capsular contraction rate is the same as for other implants types.

On a rare occasion, a patient will have had or knew of another who had a problem with the old silicone implants and prefers saline implants or if a trans-axillary incision is indicated saline implants may still be preferred.  Silicone breast implants are often recommended for patients with a history of capsular contraction with saline breast implants, reconstructive breast surgery, and those patients who are more athletic.  These newer generation silicone implants offer a variety of shapes and sizes including the popular “high profile” implant that creates a fuller, more youthful appearance.

Read more about top breast augmentation surgeon Dr. Paul Howard in Birmingham, Alabama.

Dr. Paul Howard on Google+

The Basics on Breast Augmentation by Paul Howard, MD

Breast augmentation with saline or silicone implants has become an increasingly popular option for women either born with a small chest of for those who suffer from the effects of child birth or have gained and then lost a lot of weight.  Breast imperfections compiled with the societal preference for a larger bust have caused the most frequently performed surgeries done by Plastic Surgeons to be the breast augmentation.  The operation can be a challenge to perform as there are a number of decisions the patient and surgeon must make to obtain the best results.

The first and most basic decision is the choice of breast size and the possible need for a breast lift or mastopexy in addition to augmentation.  Next, the type of implant should be explored.  Some people desire the “natural” feel of silicone implants and others prefer the improved projection and lifting obtained with saline implants.  The surgeon will usually recommend that the implants be placed in the sub-muscular position (beneath the pectoralis muscle) although on very rare occasions sub-mammary (beneath the breast tissue and on top of the pectoralis muscle) placement may be indicated.

Finally, the incision location is discussed.  There are basically four different incisions available:  axillary (armpit), peri-areolar (around the nipple/areola), infra-mammary (under the breast), and umbilical (through the belly button).  Most surgeons will know 2 or 3 of these approaches with the “TUBA” or trans-umbilical approach being the least performed incision.  In many instances the trans-axillary is recommended due to its location in the armpit away from the breast itself, the quality of the scar in the hair-bearing skin of the trans-axillary and the fact that early implant manipulation to keep the implants in position perfectly in the sub-muscular pocket without putting pressure on the breast incision.

Price shopping breast augmentation is a calculated risk as one is shopping a general anesthetic also.   New Plastic Surgeons performing breast augmentation are generally a “one trick pony.”  That is, they tend to offer implants and rarely breast lifts (which are harder to do), nor do they offer a selection of breast incisions as the infra-mammary incision seems to be the easiest for the amateur surgeon to perform.

The caveat is to always check the credentials of your surgeon as there are no “weekend” courses to teach breast augmentation.  Also, beware of the “less is more” argument.   That is, minimal training as a “cosmetic surgeon” is somehow better than completing a full Plastic Surgeon residency resulting in American Board of Plastic Surgery Board Certification as a REAL Plastic Surgeon.  Breast augmentation gone wrong is very difficult to reconstruct and shopping for the cheapest surgeon does not guarantee board certification, clinical judgment, or experience.

Read more about Dr. Paul Howard and breast augmentation.

Dr. Paul Howard on Google+

WHEN NEW IS NOT NEW

Injections of silicone into breast tissue to enhance the size and shape has been around for almost 100 years.  Soon after its inception the myriad of problems associated with silicone in the soft tissues revealed themselves and the injection of significant volumes of the substance was banned along with the other “revolutionary” injectable of the day- paraffin.  Early in the 1960’s silicone was resurrected in the form of silastic bags filled with the previously banned silicone gel creating the first “silicone” implants.  Injection ports were added to the silastic bags and other substances were tried as the filler material leading to the saline filled implant that is so popular today.  Parallel to the rapid advances in filler material manufacturers at the request of Plastic Surgeons began experimenting with more exotic fill materials, different thicknesses and texturing of the sack ultimately leading to the textures and shapes of today’s implants.  Into the 1970’s the inframammary incision remained the incision of choice until the axillary incision was introduced and popularized in the 1980’s.  That’s right, the mid-1980’s.  Personally my first transaxillary breast augmentation was done in 1985.  Normally I would not have command of events in the 1980’s, but I had the opportunity to see this patient recently in consultation for a facelift.  Her transaxillary breast augmentation with saline implants was looking good at 26 years!

On occasion when reading today’s latest advertisements certain assertions stand out.  Recently I was drawn to an ad about breast augmentation by a young surgeon claiming to perform all of the latest techniques including the “new” transaxillary augmentation.  I guess to his target marketing audience the axillary incision may be new and unique to the young surgeon, but with a little research the truth can be uncovered.  The latest or newest silicone implants are still silicone gel but improved with something called memory gel that seems to make the gel fill silicone less liquid and more discernibly shaped and coherent. This new silicone technology may or may not improve the long term results but certainly has been advertised as a breakthrough in breast implants and they absolutely charge a premium for it.

The purpose of marketing oneself as a premier breast surgeon is to separate what is offered as a Plastic Surgeon from the others doing breast enhancement. Without the marketing benefit of good credentials or a gallery of representative photos showing the quality of work performed, the only possible marketing angle available may be the assertion that one uses the newest technology not available to lesser surgeons or that one is accomplished in the newest techniques that lesser surgeons are not capable of performing. Usually these procedures are much like the previously mentioned transaxillary breast augmentation, the claim of credentials not received or expertise in operations that have been around for years may be successful marketing to a poorly informed clientele but not to prospective patients in this age and time.

Read more about top plastic surgeon Dr. Paul Howard.

Scars and Breasts

Plastic Surgeons obsess about scars.  Many people who consult with a Plastic Surgeon do so because of their ability to deal with scarring on the skin as well as our ability to create the best or least noticeable scars.  To create the best scars requires more than vigilance in suturing wounds, it requires the ability to know how scars can be expected to heal on certain parts of the body as well as the ability to use wrinkles (or relaxed skin tension lines), shadows, and anatomic structures to camouflage or hide scars.  For instance, it is a well-known fact that scars located within hair-bearing skin are more forgiving than other scars and can be well hidden within the hair of the scalp, pubis, or armpit (axilla).  Another basic premise of wound healing is the fact that tension is generally bad for scar healing.  Let us also agree that any scar visible on the otherwise flawless female breast cannot in and of itself be desirable yet it can be tolerable.

Breast augmentation seems to be one of the only Plastic Surgical procedures where surgeons will ignore many of the basic tenets of wound healing in order to make the operation easier to perform.  Honestly evaluating the currently available incisions used to place implants in breast augmentation will lead us to choose the incision most likely to leave the best or least noticeable scar.

The most commonly performed incision for breast augmentation is called the Inframammary, or beneath the breast, incision.  It is frequently chosen for many reasons, but arriving at the best scar is not among them.  Suffice it to say that regardless of the incision chosen, the ability to place the implant in the proper position is achieved leaving only the quality of the scar as evidence that an operation had been performed.   If the scar is off the breast or imperceptible, the patient can maintain what I call plausible deniability with respect to their Plastic Surgical procedure.   Without a scar as evidence, nicer breasts can be attributed to genetics, hormones, or even good luck.

The approach to breast augmentation with an incision that fulfills most if not all of our criteria for a good scar is the transaxillary, or armpit approach.  This incision is placed within the hair-baring skin of the armpit, therefore is not on the breast and is not effected by the increased skin tension created with the placement of the implant.  The incision being located off the breast allows for early implant massage which is known to improve position and “softness.”  Finally, the incision in the armpit does not indicate what operation was performed even if slightly visible.  The axillary incision does not scream “breast augmentation” as the Inframammary incision does.

The periareolar incision is located around the dark part of the nipple at the junction between the areola and the lighter breast skin.  The incision placement makes good Plastic Surgical sense because the areas between light and dark skin are good for camouflaging scars.  The periareolar incision does suffer from its placement in an area of increased tension after placing implants and is not a useful incision if the nipple/areola complex is naturally small.  This incision suffers from a further problem: it is the most likely incision to cause permanent numbness on the breast skin.  Certainly a numb nipple is not desirable regardless of the benefits.

The transaxillary incision has been around 30 years yet one hears a litany of “possible” problems using this incision.  The perceived problems include “nerve damage” due to proximity to the brachial plexus, implant malposition, “high implants” as well as other non-specific problems that seem to be due to a generalized discomfort using the incision.

Suffice it to say that most surgeons who do not offer the transaxillary incision simply do not know how to do it, are amateurs who are not board certified Plastic Surgeons, or are operating at such high volumes they choose the easiest incision to meet their time constraints.  The published Plastic Surgery literature does not recognize rare problems such as nerve damage or malposition as complications related to the transaxillary incision.

Dr. Paul Howard pioneered the use of the endoscope for minimal incision breast augmentation surgery using the armpit incision.  Read more about Dr. Paul Howard’s breast augmentation.

Breast Implant Armpit Incision

Photo shows a healed armpit scar after having breast augmentation surgery.

View breast augmentation before and after photos.