What is the Right Breast Implant Size for You?

Richard H. Tholen, MD, FACS
Article by
Minneapolis Plastic Surgeon

Choosing breast implant size can be done in a number of ways; using as many of them as possible only increases the information that I utilize to most accurately achieve the “look” each patient desires.

Of course, patients often have input from friends who have undergone this operation, have a "great result," and have ____cc implants. "Get those!" she tells you. But you probably don’t know what proportion of her present size is her breast, and how much is implant. Unless your breasts exactly match your friend's pre-operative breast size (doubtful), you will need different implants added to your own tissue to get similar results. The problem is determining what size is best for you, which can be difficult when you have other friends who advise to “not go too large” or you will “look fat,” be top-heavy, or have a "porn-star look." Compared to whom? Or is she just a bit jealous? I have seen entertainers, models, and everyday women with breasts of all sizes and shapes--some of whom ask me to give them something different: bigger, smaller, higher, or with an improved appearance. What is best for one is definitely not best for all.

Breast augmentation is a personal choice, and while a friend’s input can be helpful, you should choose a size that makes you feel good about yourself. For MOST women, the size you choose is not only possible, but perfect for you! Remember, you should never have surgery to please someone else, or to try to conform to someone else's opinion.

Plastic surgeons that perform lots of breast enlargements have extensive experience in helping our patients choose implant sizes that are compatible with individual anatomy. Every one of us does this slightly differently, and some surgeons even decide for their patient. But what about the patient's wishes? Every patient has a "perfect size" in her mind's eye, and all we need to do is figure out what that size is, and whether or not it will match appropriately with the patient's chest and breast base dimensions, skin and muscle capacity, position of the nipple-areola complex, as well as a host of individual anatomic factors. I start with breast examination, careful measurements (everyone is asymmetrical), and ask you what your goals are. Based on these factors, I can determine if your requests can be achieved. For most patients, the answer is YES! If not, I will tell you, and we try to figure out what CAN work, and how to best get CLOSE to your ideals.

One of the best techniques for choosing the size of breast implants is for the patient to bring photographs of models with the desired final breast size to their consultation, or at the time of surgery. The proper size implants to most closely achieve this appearance are then chosen in the operating room. (Since we have all sizes and profiles of saline and silicone gel breast implants available in our accredited surgical center, we do not have to “order in advance” and can make changes based on your choice, or on the basis of your exact chest wall, muscle, and breast anatomy right up to and during surgery). Photographic examples have proven to be much more accurate than the patient requesting a letter cup size, or trying to find a similar person who has had breast implants and whose anatomy and/or results approximate your goals. Don't try to match your height, weight, or preoperative breast appearance to the photos, and don't use a stated implant size as a guideline for choosing your implant size—just find an “AFTER” photo you like.

Also, if your breast sizes don’t match (most women have some degree of asymmetry), we can choose different implant sizes and/or profiles to achieve as much symmetry as possible. In more severe cases, we can recommend appropriate procedures (such as breast reduction, breast lift, or other surgical options) to optimize size, shape, and position between mismatched breasts.

Trying on implants in a brassiere or stretchy top is another excellent way to provide some idea of desired final breast size and the implant volume needed to achieve that size; however, it is essential not to become overly attached to a specific bra cup size (B, C, D, etc.) or implant volume (400cc, etc.), since the implant size you like in a bra or top will always look smaller when it is under your own breast tissues and chest muscle. Typically, a woman who chooses a specific cc volume implant that she feels looks good in her bra will be disappointed (too small) after surgery if that exact size is used in her body. A good general rule of thumb is to add 50 to 100cc to the implant volume you feel looks good if you choose to size in a brassiere. In other words, if you like how a 400cc implant looks in a bra, it will take a 450-500cc implant to look about the same size in your body.

Since what this surgery accomplishes is increased volume, your own pre-surgery breast shape will determine your final breast shape after implants increase your breast size. Size will also determine just how much breast mass extends to the side of the chest (armpit area), or into the cleavage region, since proper implant positioning is determined by the position of your nipple areola complex.

For instance, a woman with widely spaced nipples will need to have her breast implants positioned more laterally (towards the armpit area), since the implant pocket and final breast mound must be properly centered beneath the nipple areola complex. If the implants were simply placed close together in the center to give a full cleavage look, each nipple areola complex would then be positioned too far to the side, giving a "wall-eyed" appearance.

Similarly, a woman who has more medial nipple position would have a "cross-eyed" appearance if she requested lateral fullness and her implants were placed more to the side of the chest without taking into account the nipple position atop the new breast mound.

Clearly, not only size, but also the exact size and position of your breast implants, is critical to your final result. Your own anatomy determines shape (unless you also need a breast lift, where incisions are made to lift or otherwise shape your breast skin, or reposition too-low nipple and areola complexes).

Most breast implant patients will notice that implant position tends to drop as time goes by after surgery. If you look “perfect” in the first few days after surgery, I believe that even wearing a surgical bra 24/7 will not prevent implant position from dropping to an unattractive “too-low” appearance in a majority of patients after several months. (This also makes the scar position too high above the crease.) I take this into account surgically, placing the implant position slightly higher than I anticipate the desired final position to be. I will have you use an elastic bandeau at night, and go braless during the day (when upright), to allow the implants to settle, drop, and soften as time goes by. The elastic bandeau also helps me adjust any differences between breasts, since each side will swell, bruise, scar, and heal slightly differently, and at their own individual rate! I firmly believe that looking a bit “high and tight” right after surgery ensures a better final result, and a lower likelihood of re-operation to adjust position. In those few patients that do not drop into “perfect” position, it is a much more simple (and successful) re-operation to open the pocket slightly lower than to try to raise the crease and keep it “high enough.”

I also make the surgical pockets larger than your chosen implants, and will have you do implant movement exercises, often inaccurately called implant massage, to keep the pockets open and larger than the implants so that the final breasts are soft, natural, and drop slightly to the side when you recline (which is what naturally larger breasts do), rather than remaining hard and immobile on your chest.

Most women seeking breast implants at Minneapolis Plastic Surgery emphasize that they do not wish to be "too large" after augmentation. There is a natural hesitancy to make a change that is so dramatic that "everyone will know" or that might make you more self-conscious at the health club or swimming pool. Most patients have these concerns, and many verbalize this. However, 6 to 12 months after surgery, when these concerns evaporate, too many patients admit they wish they had chosen larger implants. Some undergo another operation to place new, larger implants. Fortunately, the surgical pocket for the implant is already healed, and recovery is quicker when size change is requested.

Although the choice of size is entirely up to each individual patient, subject to anatomic limitations, choosing just slightly larger than what you consider to be optimal preoperatively will help you avoid reoperation for size change, including the cost of new implants, operating room, and anesthesia.