10 things you probably didn't know about breast implant size

chess on 15 Sep 2009 at 12:00am

The more questions I answer for RealSelf the more I have realized that there seems to be a lack of help, for some patients, to determine the correct size and style of breast implant for breast augmentation. Whether this is due to a failure of plastic surgeons to assist their patients in the decision making process, a lack of understanding on the patient’s part of the complexity involved in choosing implants or an over abundance of haphazard information from both the surgeon and the internet that ultimately confuses patients, I’m not really sure.

So in an effort to help all patients here are 10 things patients need to think about when choosing breast implants.

1. Don’t Think About Bra Size

The most common comment I hear during a breast augmentation consultation is “I’d like to be a “C” cup.” And, although I have come to interpret this as “I’d like my breasts to look like they fit my body” that may not mean you’ll be a “C” afterwards.

All bra manufactures size differently and therefore bras from different manufacturers will fit differently. You may be a 36 C in one bra and a 34 D in another. So don’t worry about the bra size. If you end up as a “D” cup but are happy with the appearance of your body, then the bra size is irrelevant. Work with your surgeon to determine the implants that give you the look you desire.

2. Know Your Body

Height, weight, body frame, shoulder width, hip width, buttock and starting breast volume need to be taken into account when choosing an implant. In general as all of these areas increase in size (except starting breast volume) the larger the implant necessary to maintain proportion. A woman 5’3”, 110lbs with a small frame will typically need a far smaller implant than a woman 5’10”, 145lbs with a large frame. It’s not easy to stand in front of a mirror front-on and from the side and take a very critical look at your own body. But doing so will greatly increase your knowledge and appreciation of your body and therefore your ability to choose the correct implant.

3. Personality and Social Perception

Whether you’re an outgoing, Type A personality or a quiet, shy, Type B personality there’s an implant that will enhance your body while maintaining the real you. It is important that you convey to your surgeon how you want to be perceived by the public. Breasts that are larger than what would be proportionate may be perfectly suitable in certain professions. But implants that create proportionate breasts will allow clothing to fit well and make you look great in a swimsuit or cocktail dress, without attracting unwanted attention in a professional environment.

4. Your fitness routine

If you’re the type that likes to seriously sweat at the gym, run or bike extensively or doing any kind of sports than you have to consider the trade off between larger breasts and performing your activities at your current comfort level. This isn’t to say that breast augmentation will limit your activities. But, larger breasts will feel differently, need more support and frankly if too large, could be cumbersome during work-outs. You need to have a frank discussion with your surgeon concerning this. A smaller or lower profile implant may be necessary to achieve both goals.

5. Breast implant style

Both Allergan and Mentor make low, medium or moderate and high profile implants. As implants move from low profile to high profile the amount of projection increases and the base diameter decreases for any given volume. These implants can either be round or shaped (also called anatomic, contoured or tear drop). For the most part shaped implants are used in breast reconstruction-there is no need for them in cosmetic breast augmentation. Shaped implants provide shape when there isn’t any but have the potential to rotate causing problems.

To make it easy a majority of patients will be appropriately enhanced with the medium profile implants. The only real difference between the two companies is that there is slightly more projection with the Allergan implants than the Mentor implants for any given volume.

I have found that high profile implants tend to suit shorter, smaller framed women with a narrow base width. Conversely low profile implants are great to give upper pole fullness in augmentation mastopexy or to add fullness without the added projection in women with adequate breast tissue.

6. Don’t get her breast implants

Another common comment is “my girlfriend has 400’s so I think I should get the same because they look great on her.” But the operative words here are “…on her.” Even though you and your friend may seem similar in terms of body size there are too many other factors that must be considered to make such a blanket statement. Think of this process as the ultimate in customizing and be open to different implant sizes or styles.

7. Use sizers

Sizers are silicone gel implants that can be used in the office to give patients an idea of what they can expect after surgery. Wearing a tight sports bra while trying on sizers gives better compression and thus a slightly more accurate idea. However, sizers tend to sit lower in the bra than breast implants so your surgeon needs to guide you while trying them on. They aren’t perfect but they do give a good estimate of postoperative size. In my practice the use of sizers has eliminated postoperative complaints about breast size.

8. Bring a friend to your breast augmentation consultation

I tend to spend a lot of time, during breast augmentation consultations, educating patients on all of these topics. Because there is a lot of information to digest, patients don’t always hear or remember everything that I tell them. Having a friend or relative with you during the consultation increases the amount of information that is attained. In addition these friends, if they understand your desires, can lend another set of eyes that can help determine the best implant.

9. Don’t be afraid to visit your plastic surgeon more than once

At the initial consultation patients and I usually decide on the correct implant most of the time. If there is doubt it can usually be clarified at the preoperative appointment. Occasionally, patients have difficulty accepting the appearance of their breasts (with the sizers in). They’re simply not accustomed to the new look. In these cases I have them see me for an additional appointment or more until they are confident in the choice of implant. Although most surgeons don’t do this, don’t be afraid to visit your surgeon on a separate occasion.

10. Don’t let your surgeon tell you what size you should have

I have found through my work with sites like RealSelf that patients are often left out of the decision making process or simply allow their surgeon to determine the correct implants, only to be disappointed with the outcome. Determining the correct implant must be a collaborative effort between patient and physician. Use your surgeon as your guide. Use the surgeon's knowledge, sizers and experience to come to a conclusion that is appropriate.

Virginia Plastic Surgeon Christopher HessGuest post by Christopher L. Hess, MD, FACS.
Dr. Hess is a plastic surgeon based in Fairfax, Virginia.