Almost every breast augmentation consult at Southwest Plastic Surgery starts with a number. 300. 400. “My friend got 450.” The number is rarely the right place to start, and Dr. Agullo says so in nearly every sizing answer he writes.
Since 2010 Dr. Frank Agullo has answered more than a thousand patient questions on RealSelf.com. Below are five about size and profile, paraphrased with the identifying details removed, with his answers lightly edited for the page. The full set of ten is on his surgical site.
“After a breast reduction, how do I pick the cc and the profile for an augmentation?”
Answered on RealSelf, May 2026.
CC is your last step, not your first. After reduction the breast base width will dictate the size of implant you can receive. For most people that are 5’8″ 155 lbs breast width will be 12-13.5 cm and thus would receive 300-375 cc implants. Anything larger will cause side splay and possibly stretch marks which can be seen after 2 years.
Breast reduction leaves a smaller skin envelope and space for implant. CC size is important but CC alone does not give you upper pole fullness or cleavage. Cleavage is better with a moderate-plus implant which has a natural slope to it. More projection to the front and thus more cleavage with a high profile implant. For post reduction patients I do dual plane placement of implants to give the cleavage look under the muscle. I use smooth round silicone implants.
I always bring implant sizers to be tried on in a surgical bra in my office in the exam room and also take measurements including pinch and base width with me to consultations. Pictures tell so much more about implants than CC sizes.
“I am 4 foot 10 and 100 pounds. What size works on a petite frame?”
Answered on RealSelf, May 2026.
At 4’10” and 100lbs, the diameter of the base of your chest may limit your implant size. On average for the petite patient the base diameter of the chest wall is 11 to 13cm which will typically be 200 to 300cc for a natural looking implant. Don’t sweat the small stuff, as 20 cc is barely more than a soup spoon (a soup spoon is 15 cc).
“220 cc low profile or 255 cc moderate profile: what is the real difference?”
Answered on RealSelf, Nov 2023.
Moderate profile (255 cc) is a choice that may look slightly narrower and project slightly more forward, which gives the breast a more perky look.
Low profile (220 cc) is a choice that may look slightly wider with slightly more fullness in the upper pole of the breast, but would not project forward as much.
I think you’re right that there isn’t a whole lot of difference between these two implants. Keep in mind the implant profile refers to how much the implant will project forward from your chest wall. Moderate profile implants project out slightly more than low profile implants. Volume refers to the amount of salt water (saline) or gel (silicone) that is put into the implant to inflate it. In general, the more volume you have the bigger your breasts will look. Both of these can give you a natural and feminine look on a petite frame without drawing undue attention. I would speak with your plastic surgeon about which implant he/she thinks would look best on you and why. Many plastic surgeons use 3D imaging programs or other types of computer imaging to help patients visualize what different implant sizes and profiles will look like on them. This may be helpful for you as well.
“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).
“I am downsizing. Would 195 cc be too small?”
Answered on RealSelf, Dec 2023.
Based on what you have shared with me, it does sound like you may be interested in reducing the size of your breasts by about a cup and a half. Whether or not that is accomplished by choosing the 195 LP or 220 LP implants will be dependent on what you are trying to accomplish, but keep in mind that the difference between the implants is only 25 cc’s (less than two tablespoons, since one tablespoon is 15 cc) and 5 mm in diameter. In order to make sure that the implants don’t migrate too much in their pockets (especially since your pocket is already formed for a larger implant), you may benefit from a pocket reduction procedure, which may involve mesh. Also, a small doughnut lift may be recommended in order to tighten up your breasts and better adapt the breast tissue to the new implant size.
I hope this information will help you in making a decision about what implant sizes you would like to consider. Keep in mind that there are not significant differences in size between the two implants you are considering. I think it will be very helpful for you to discuss this further with your plastic surgeon at the time of your consultation.
What the five have in common
Dr. Agullo measures the base width of the breast and the pinch of the tissue, has the patient try sizers in a surgical bra in the exam room, and only then talks about cc. Profile is chosen at that width: a higher profile projects more without getting wider. A difference of 25 or 50 cc is a soup spoon or two and is not visible on the body. Going much bigger stretches the pocket and thins the tissue; going smaller needs the pocket tightened, sometimes with mesh and a small lift.
Ten of these, with a short-version table, are on Dr. Agullo’s surgical site, and the first roundup in the series, on bottoming out, double bubble and waterfall, covers what happens when the width rule is ignored. Visible ripples have their own post: breast implant rippling.
Why Southwest Plastic Surgery
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and is Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has named him a Top Doctor every year from 2014 through 2026. Breast augmentation is one of the most common procedures at the practice, and sizing is done the same way every time.
Ready to talk?
Bring your wish photo. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. More of Dr. Agullo’s answers are on RealSelf. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
