Breast implants - how do I choose the right size?

Hello,

Breast implants can be placed to look good over time at moderate sizes. Larger implants give a more "fake" look at the risk of needing much more surgery over time.

You really need to decide upon the look you want and consider the risk profile of going there. Then when you have considered all of this, you are prepared to make a choice.

Best Regards,

JPD

The patient's natural breasts have a certain diameter. In our practice we believe the implants should not be larger in diameter than the patient's natural breasts. Since the implant types and shapes are well known, you can figure out the maximal size, and decide from there.

Remember, the larger the implant, the more destruction of the muscle attaching to the sternum must be to fit in the large implant, and the more the implant will stick out into the armpit. The surest way to have surgery after surgery is to pick very large implants.

Choosing the implant size

In consultations I listen carefully to each patient to ensure that I clearly understand their goals for breast augmentation surgery. Based on that discussion, and on the physical examination, I go into surgery knowing what the ideal volume should be within one or two implant sizes. However, the patient and I do not decide on one particular size prior to surgery. There is absolutely no way, in my opinion, to know exactly what size implant is the ideal size for a particular patient in advance of creating the implant pockets in the operating room. For that reason I have a wide range of implant sizes available in the surgery center.

If a natural appearance is the goal, then the way to get the size right is to ‘try out’ different implant volumes in the operating room. Once the implant pockets have been created, I place a ‘sizer’ in one implant pocket and have the upper half of the O.R. table raised so that the patient is in an upright ‘sitting’ position (chest fully upright). The sizer is then inflated gradually to the point that the breasts appear full, but not unnaturally so. In this manner the exact volume that produces a full but natural breast profile is determined.

For any patient there is obviously a range of implant volumes that would be considered natural. While one patient may seek an augmentation that is ‘the small side of natural’, another may be interested in something that is more on ‘the full side of natural’. By using implant sizers in the O.R to determine exactly what breast profile is produced by a given implant volume, I am able to provide patients with the closest possible approximation of their preoperative goals.

Sizing breast implants should not be guess work. First of all, the patient needs to clearly describe what "look" they are hoping to achieve. Each person starts with certain physical features that must be considered. Their height, weight and volume of breast tissue are important.

The diameter behind their breasts gives the surgeon the diameter of implants that would look good on that patient. Implants that are too narrow look like tennis balls with a mile between them. Those that are too large look distorted and bizarre.

The profile of those implants will then determine how natural (moderate profile) or full (moderate plus profile) or buldgy (high profile) their result will be.

Some patients are built to look large quickly. They may have a thick pectoralis muscle or a short distance from the inframammary crease to the clavicle. Others may need a bigger implant because they have a very hollow upper chest and a long distance from the collar bone to the crease.

Make sure you ses many photos from your potential surgeon to be sure the look his/her patients have is what you are hoping for yourself.

When I interview a prospective breast augmentation patient, the first thing I need to get straight is how obvious an augmentation do they want. My experience is that most women don't want a flashy augmentation. They usually want to go 1-2 cup sizes up to better fit their other proportions. Patients with realistic goals always do well.

When overly large implants get put in, the most common complaint I hear it that it is difficult to put on deodorant and shave the underarm area. With that in mind, I always measure the width of the patient's breast at a point just above the nipple. Then I do a pinch thickness test to determine how much breast tissue coverage they have. This last piece of information helps patients pick which type of implant (saline vs. silicone) works best for them. Patients with thin breast tissue do best with silicone implants. If they have ample breast tissue then they can use either type of implant.

The final aspect of the decision making process is to decide how much projection out from the body the patient wants/needs. Implants generally come in three projection styles: moderate, moderate plus, and high profile. When patients use the implant sizers in my office they give me an idea of the volume they would like added to their native breast tissues. I then take this information and determine how narrow their breast widths are. If they are narrow, they do great with high profile implants which push out more than get wider as you increase the size of the implant. This helps give them standing cleavage without forcing the implants out into the underarm area. For wider breasts, you can use less projection to get the same overall volume increase. Your doctor should have charts from the implant manufacturers that they can show to you to help pick the ideal implant for you.

I hope this helps you.
Dr. Shah

This is a very long discussion that takes place after a thorough physical exam.  There are several physical features that impact the size, shape, and route of an implant that would best suit you, including:

• Stretch of the skin
• Base diameter
• Nipple areola size
• Goal size

These are just some of the things that are reviewed. 

Now with so many choices of implants:

• Moderate profile
• Moderate plus profile
• High profile implants

We have so many options to provide you with the best result we can.

Implant size is based on your breast width, skin elasticity (i.e. whether you have breast fed before or not or lost a significant amount of weight), and amount of breast tissue you have to camouflage the implant.  The more you have in each of the above categories, the bigger the implant you can have.

However, it is important to pick an implant that is proportional to the rest of your body.  If you pick too small of an implant then it will look like a little tennis ball under your breast.  If you pick too large of an implant you will look too top heavy. 

I usually measure the patient in the office and then have the patient try on bras with various size implants that fit within their body dimensions.  Together we pick a size that best suits the patient and will give you the look you desire.

Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. (Use the measurement key below)

Step 2: Place 250 cc of rice on one side and 300 cc on the other side. (or any amounts you desire).

Step 3: Whichever side you like better, then put the same amount on both sides and wear different styles of clothes around (tight and loose) for a couple days and see what you think.

• 1 cup = 236cc
• 1/2 cup = 118cc
• 3/4 cup = 177cc
• 1/4 cup = 59cc
• 1/3 cup = 78cc
• 2/3 cup = 156cc
• 1/8 cup = 30cc

It depends on the size of your frame.  

• f you are an A cup now and want to be a C or D, and your frame is Medium to Large, you will look in proportion. 

• If you have a very small frame a D might look large on you. 

Log on to the website below; there you can enter the breast size you are now and your weight and the breast size you would like to be.  Pictures will come up of people in your size so you can get an idea of what you will look like.

The choice of implant size depends on multiple factors, including, amongst other factors:

1. Current breast size and shape
2. Extent of ptosis (droopiness)
3. Chest wall shape and more specifically the base width of the breast
4. Extent of enlargement that you are hoping to achieve
5. Type of implant being used (profile of implant, saline vs. silicone gel implants, shape of implant (round vs. contoured implants).
6. Body habitus, such as height, waist and hip size. I find that the wider one's chest is, the larger the implant that would be tolerated. Also taller patients as well as those that have wider hips do better with larger implants.

The goal of the operation for most patients is not to look 'top-heavy', but rather for the implants to complement the rest of the body, so that if you wear a tight shirt or bathing suit, the operation will be evident, however if you choose to wear a loose shirt people may not know that you did anything. I want my patients to have the option of showing their busts depending on their clothing choice.

I have my patients go to the store and try on different bras at the store.  Remember that you can only change the bra cup size not the band size, so if you are a 34A, you should try 34B-C-D not 36.

Stuff the bra you pick and wear the bra for a few days in different clothes and see if that is really what you want.  Then bring it to the office, and I would size you to see how big of an implant would be needed to achieve that size.  

Depending on the your size and the size of the implant desired, we then discuss if what you have chosen is a good fit for you.  The size you can have is limited by the:

• Quality/elasticity of your skin
• Width of your chest
• Amount of existing breast
• Size of implants available

When choosing a size for breast implants it is extremely important that both the patient and the surgeon are on the same page. This is a surgery that you want to get right the first and only time!

It is important to note that one manufacturer's D-cup bra may be the same size as another manufacturer's C-cup bra. Therefore, I have all of my patients choose "want-to-be" pictures either from one of my before and after books, or from an educational site that I refer them to.

I place these pictures on the wall in the operating room and use sizers until I have a match. This helps to choose the precise implant volume that will match my patient's desires. This will also help to determine the projection of the implant chosen, as some women desire fullness approaching the armpit and others dislike this look.

Of course, implants must also be matched to the measurements of a woman's breast diameter and the amount of breast tissue that is present to start.

The most important factor in determining the right size is a long discussion with your surgeon about available implants, incisions, placement and then choosing a picture with a breast volume you find pleasing.

There are a number of factors to consider when deciding on an implant size.

I am not a big believer in having my patients bring in photos because this does allow you to factor in the volume of the natural breast tissue in addition to the implant. One implant can give completely different results in two different women.

The dimensional approach makes the most sense to me - choosing implants based upon your natural breast width as well as the tightness of your tissues. Once measurements are taken, then you can size with the actual implants to get an idea of what to expect.

It is well known that what you see is larger than you will be after you have healed from your surgery but giving a percentage is difficult. The only true promise I can make my patients is that they will not be larger than what they see while sizing.

The concept of using rice I feel is too inaccurate to give any useful information.

There are a number of ways that one may pick the right size implants for themselves.

• One way would be to bring in pictures of other women's sizes that they think would look good on them.

This is somewhat subjective, and leaves a lot unanswered, as it depends on the plastic surgeon's experience level to be able to match up the size and shape of someone in a photo to the patient bringing it in. There can be differences in height, weight, and shape of the chest wall from a photo to a patient, but this can be valuable.

• Another option is to try on sizers in the office. This means putting an implant in the bra to get the preferred look.

There is usually a conversion volume that needs to be added or subtracted to come up with the correct size. In my office that volume is 50 grams more than what is placed in the bra. The reason for this is that the pectoralis muscle flattens out the implant when it is in the patient.

So to get the look of the sizer, I have to add 50 grams to the sizer to convert to the actual implant. This is the favored way for my patients to choose the appropriate size.

• A new way to choose implant size is to use a 3-D camera with computer simulations that may help in selecting the size and shape.

There are currently at least two 3-D systems available. They are Axis 3 and Canfield Medical. These take your own photo and convert it to the virtual size that you tell the computer to simulate.

I find that patients really like to participate in selection of their size, so the more interactive it can be for the patient, the more they like it. We actively try to encourage our patient's input.

I do not commit to a specific size implant before the operation. That would tie my hands. I have a careful discussion with my patients, which may include asking them to bring pictures of what they hope to look like after the surgery.

During the operation, I put in temporary implants to determine what looks best in accordance with their expectations. (I have every size implant in my operating room.)

When a patient wants to be much larger than they are, I will tell them that I will make them as large as I can and still have them look natural.

Choosing implant size is the most difficult decision in breast augmentation surgery. I typically use four principles in my practice:

1. I have you look at four sets of pictures that give me a general sense of the look you are seeking by asking the question, "if these were your breasts would they be too large, too small or about right?" People typically fall into the four categories of an athletic C cup look, a full C cup look, D look, and supersized. This allows the surgeon to get a rough idea of the "look" you want.
2. Then, I have patients place sizers in a bra we provide and under their normal clothing. This only approximates the volume needed.
3. Measurements of your breast are taken to pick an implant that fits within the natural dimensions of your breast.
4. During surgery, I use a temporary sizer to see how the implants fill out your existing breast shape, and I ask my patients to allow me 25-50 cc's of wiggle room to get them a better result if I see fit at the time of surgery. A small minority of patients are still very nervous about the size before surgery and wish to pick an absolute size, which is appropriate as well with guidance about how the implant characteristics will change once under the existing breast.

Good luck!

The best way that I know of (and one I use for my patients) is to try the implants on during a consultation.  There is nothing like seeing the implant on your body. Everybody is different and has a different breast /chest size. You cannot rely on the pictures and other people's experience.

Choosing the right implant size is one of the most important elements of breast augmentation surgery. It is a process involving both the patient and the surgeon.

In my practice, the following steps are taken:

1. Patient expresses their desired size - often in terms of "cup" sizes.
2. I examine the patient and make breast measurements (breast width, sternum to nipple distance, nipple to inframammary fold distance, etc).
3. I then have patients do sizers with various bras. I have a home kit that allows patients do the size trials at the comfort of their home. I want patients to take their time with this process. I encourage patients to try on various clothing (swimwear, intimate wear, sweater, etc) until they find the size they feel most content with.
4. And then I reconciliate, i.e. - I determine whether the size chosen by the patient can be placed based on the anatomic measurements and breast tissue/skin compliance.

For the most part, I try to minimize my input for the size determination, as I truly feel this is a personal decision, and ultimately, patients have to feel content with the size chosen. However, if I feel that the size chosen is not compatible or may compromise the outcome (too tight looking, etc), then I will discuss my concerns with the patient to convey the pertinent anatomic considerations.

It is important to remember that an implant in itself is just one component that determines the size outcome. Obviously, it is in addition to the native breast tissue. Also, the very same implant placed in 3 different women of different height, weight, and physique will produce dramatically different size outcomes. This is the reason why I discourage patients from choosing the size based on photos or friends telling them what size will be "perfect" for them. Size has to be placed within the context of the specific patient's body/breast to have true relevance.

Lastly, although, we discuss breast sizes in terms of "cup" sizes, implants come in "cc" filling volumes - i.e. - how many cc's are prefilled (in case of silicone implants) or desired filling (in case of saline implants). So ultimately, most plastic surgeons do not guarantee a certain "cup" size, although unfortunately, it is the only "language" that we have for commmunication. In my practice, I try to focus on the "look" rather than the "cup" size. My home kit is based on the appearance in front of a mirror, while the patient is "blind" to the actual volume. This allows patients to choose the size mostly based on "what they see" and not on "what they think they need."

Ultimately, there are many ways to determine the right size. My method is just one way that works for me and my patients. Be sure to discuss with your surgeon their preferred method, and see if it makes sense to you.

Be actively involved with your size - after all, it's your breast/body, and you have to be happy with it.

In general, I tell my patients that each person is destined for a specific size based on their breast skin, fat, and glandular quality and size. There are exact measuremnts that can be made to use as a guideline in choosing the right size.

Another interesting point is that your breasts are probably meant to be as big as they are going to be if they were engorged with breast milk. This is one of their main functions. Some people grow a lot and some a little. If the skin and breast tissue is stretched beyond this "destined" size, then problems can occur with the implant pushing, stretching, thinning, and damaging the breast skin/tissue early, and then revisions are needed.

Also, you have to ask yourself what you mean by "breast size." Many patients confuse size with fullness in the upper part of the breast, the area which shows with low cut clothing and certain cleverly designed bras. If it is fullness here that you want, then you may not have to go so big as you think.

Lastly, if a lift of the nipple areola is needed, then this is often done in conjunction with the augmentation. A common problem is when someone has had their breasts augmented to a really large size to treat the sagging. Moderate to severe sagging must be treated with an appropriate lift with or without an implant, period!

Look in magazines. Look at friends who have had augmentation. If you have really tight breasts that are small, then there are further limitations. You have to be realistic and do what is safest for your body LONG TERM. Not just for short-term satisfaction.

I have a lot of thoughts on choosing the right size breast implants.

• Show your surgeon images of what you consider ideal breasts.

• Have your surgeon place different sizers in your bra to see what you like. 

(These two maneuvers will give you an idea of what size you want.)

• Your surgeon should measure the diameter of your breasts, the thickness of the breast tissue, and the degree of sagging.

• The biggest safe implant will have a diameter that is about 1 cm less than the diameter of the breast. In a narrow breast, use high profile implants.

• If the largest implant that your surgeon considers safe will not give you the size that you want, talk with your surgeon. He or she will explain that you will have a fake looking result with excessive fullness on top of the breast. You will also have increased risk of complications with excessively large implants, such as diminished nipple sensation and stretched tissues.

• If you want to look natural, take your surgeon's advice. Instead of choosing an excessively large implant, tell your surgeon to use the largest implant that will leave you looking natural.

• Your surgeon shouldn't make the final decision on implant size in advance. Once the breast pockets are made, your surgeon should insert disposable implant sizers (they only cost $45), and try different volumes. From there, the surgeon should place the operating table into a sitting position so that he or she can really judge shape and symmetry and keep different size implants available.

• If you insist on an inappropriately large size, you may be turned away. This will actually improve the reputation and income of your surgeon in the long run, and it will definitely improve your surgeon's peace of mind in the short run. 

• Many surgeons have an "I don't do strippers" policy. 

Go to an experienced Board certified plastic surgeon (by the American Board of Plastic Surgery) and have a full consultation with evaluation. It is important to pick the correct size implant based on what fits your body best.

• The width of your chest, and the original size of breast are two large factors.
  • If you have a small chest and a minimal amount of skin and breast tissue to work with, then the augmentation should not be so drastic that your body cannot physically accommodate it.
• It is much easier to decide all of this with the help of your surgeon, and also a range of different implants to “try on.” I always have my patients “try on” implants with a bra and fitted shirt to get a better idea of what works best for them.