650 or 700? 430 or 490? 220 or 255? Patients ask me to choose between breast implant sizes all the time. Often after weeks of research on websites and forums, studying “wish” photos and even trying on a friend’s implant. What almost never comes up in these discussions is the most important number, the width of the patient’s breast!
Below are five questions I have received through RealSelf (one in 2013, one in 2018, and three this year) about breast implant sizing and profile, paraphrased with the patient-identifying information removed, along with my answers, lightly edited for the page.
“My chest wall is uneven and my breasts sit low. Which cc and profile should I choose?”
Answered on RealSelf, May 2026.
Never mind the cc number she gave you. Your natural chest width is what determines the implant.
Personally, I would avoid teardrop implants. They are textured, and texture has been linked to a rare type of lymphoma.
If you want that look, a round implant like the Motiva Ergonomix, which moves with your body, is the closest thing.
“I am 5 foot 1, 105 pounds and a 32A. How do I choose a size and profile?”
Answered on RealSelf, Jul 2018.
Breast width is the most important consideration when choosing size and profile. Ideally, your implant should be about 1 cm narrower than your breast width. That is the reason the profile goes up as the implant gets bigger: it keeps the implant width down. An implant that is wider than ideal is more likely to cause rippling, a top heavy look, lateral implant displacement, or side boob.
“My implants ruptured. For the replacements, 430 or 490 at the same width?”
Answered on RealSelf, May 2026.
If by “not massive” you mean close to your goal then I would go with the 430 cc. The 490 cc is the one that sails past “not massive” and into done.
Keep in mind that since you have little to no breast tissue to begin with, the 490 cc high profile implant will stick out further off of your chest wall than the 430 cc implant will (they are both 12.5 cm in width). This may give you more of an edge effect and cause your skin to stretch more over time especially in the lower pole.
I would not recommend sizing based on your photos as they are very dark. If you want to visualize what each implant size would look like, I would recommend using your photoshopped photo and showing it to your plastic surgeon. Then use implant sizers/sleeves to see what size would get you closest to your goal photo. If your goal photo is between your current implant size and the 430 cc implant, use a 100 cc sizer/sleeve. If your goal photo is between your current implant size and the 490 cc implant, use a 160 cc sizer/sleeve.
“I am 450 cc now and want 650 or 700. Is 50 cc a big difference?”
Answered on RealSelf, May 2026.
At 5+ years post op your pocket is very stretchy and accommodating, going from 450 to 650/700 will be a noticeable difference in your breast. Going from 650-700 in a stretchy pocket will not make as big a difference (for most people). 50 cc inside a five-plus year stretched pocket reads as a quarter cup to nobody.
Some things to consider with a significant upsize. As your pocket gets larger your skin will get thinner. The larger your pocket, the higher your risk of capsular contracture. If your IMF (the breast fold) is not reset when you go up in size you may bottom out more. If you are on the thinner side you may see rippling. A high pocket will give you more fullness up high with an upsize (some love this, some do not).
Have your surgeon use implant sizers and a bra to determine the best size for you! Also don’t forget to discuss profile as even at the same cc a moderate plus and high profile implant will give you different results (width/projection).
“One month out and I feel I went too big. How soon can I have them out?”
Answered on RealSelf, Nov 2013.
It is very unusual for a woman to find her breasts too big after augmentation, and of those who do, most adapt within two to three months and are happy with the result. At one month you are still quite swollen and the implants can ride a little high, and both improve over the coming weeks. I would wait at least three months before deciding on any further procedure.
The three things I say in every sizing consult
Implant sizing is determined by breast width, which determines implant width (implant width will be about a centimetre less than your breast width).
Profile represents projection for a given implant width. It is what allows a bigger implant to fit within the same width.
Volume: you would not be able to tell the difference between implants that differ by 50 cc. Remember, a soup spoon is only 15 cc. Always use implant sizers in a bra to help with volume selection. Do not just choose based on the numbers.
Ten of these, with the short-version table, are on my surgical site. The first roundup in this series, on bottoming out, double bubble and waterfall, is what happens when rule one is ignored, and rippling is what happens when a thin patient ignores rule three in the wrong direction.
Why choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, completed my plastic surgery fellowship at the Mayo Clinic, and serve as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has listed me as a Top Doctor every year from 2014 through 2026. I size the same way every time: measure, pinch, sizers in a bra, cc last.
Ready to talk?
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. More of my answers are on RealSelf. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.