This is not the best way to select implant size.

To ADW,

Hi.  You have already had your surgery, and I hope that everything went great.  My answer is addressed to other women who may read this as well.

1)   The surgeon must know the look you want.  Show her or him a picture of what you consider ideal breasts.  The surgeon must agree that this is a reasonable look for your anatomy.  In general, don't go too big.  Large breasts don't age well, and very large implants have more complications and look fake.

2)  Then there is a simple maneuver that eliminates all the guess work from choosing implant size. During surgery, after the implant pockets are made, I put DISPOSABLE  IMPLANT SIZERS into the breast pockets.  Then, the patient is placed in the sitting position (you are still asleep, of course), and we try different volumes of saline in the sizers to see which size gives the desired result.  Then, and only then, do we discard the sizers, and open the correct permanent silicone implants.

3)  This maneuver only takes a few minutes, and a sizer costs only $45.  It is REALLY worth it.  It is a bit of a mystery to me why everybody doesn't do this.

4)  Implants do look a little smaller once they are inside you, about 10 or 20%.  In the long term (after the muscle stretches), I don't think size is much affected by whether the implants are over or under the muscle.

5)  Putting implants in a bra, and then putting on a tight T shirt to see what you look like, is not a bad idea, but only as a very preliminary step.

The hardest part about performing breast enlargement surgery is getting on the same page as my patients with regard to breast size. Often, there are conflicting points of view that confuse an already nervous patient. There are friends telling the patient that they should not do it at all. There are those at the other extreme telling them to go as big as possible. And in the middle are friends telling them that they should go bigger than the doctor suggests or more specifically the dreaded " I have 350's, that is what you should get!"

Lets start by saying that breast enhancement is not for everyone. So those friends that tell you not to have breast enlargement are obviously in that camp.

For those that think you go as large as possible are looking at the media driven ideals that bigger is better. However, consider the serious risks to your health when going very large. At the least, you set yourself up for early sagging breasts and neck or back pain. From an aesthetic point of view, you are no longer considered to be natural. Very large implants scream "Look at me!". If that is what you want - great- but don't do that because your friends or a passing boyfriend suggest it.

Finally, for those in the middle, wavering between sizes - go and have a long discussion with your doctor. Make sure that he or she is on the same page as you. All implant discussions should start with evaluation of your chest wall width. This will create a limit for the width of the implants. Then decide on the type of projection you desire. I tell my patients that projection comes in three sizes 1)natural and full 20Natural but very sexy and 3) In your face. This translates for the physician into low, medium or high profile implants, respectively. The dimensional concept negates your frineds request for you to get the same ones as her, because her chest width and preexisting volume may be much different than your own.

Once you know the volume, go perform a rice test at home. Pour rice into a measuring cup to the amount decided. Then pour it into one leg of a pair of panty hose, tie it off and insert in your bra. This should mimic the volume of the implant but appear about 10% larger than the actual volume. Hence, if you like 330cc in rice, then you would like 360cc when placed under the skin, behind the muscle.

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I find that choosing to go under the muscle and using a silicone implant both are factors in selecting the proper implant size.  Silicone implants are underfilled (except for some newer versions used in Europe), and have different tactile and visual aesthetics than saline implants, which are usually overfilled like a water balloon would be if you were trying to smoothen out its edges. I usually compensate by choosing about 25-50 cc more in a silicone implant than I would for a saline implant to get a patient to the same desired size.  Going under the muscle makes the slope of the breast more natural in the upper pole, in my opinion, but some of the acute projection is lost if you were to compare it to an implant placed under the gland. Implant projection or profile also has a lot to do with it. For a given base diameter, a moderate profile implant has less projection than a high profile implant. That means that you will look fuller in the superior pole of the breast with a higher profile implant. I commonly use moderate-plus (Mentor) or midrange (Allergan) implants as I feel that they give the most natural results to get my patients to the size they are requesting. I also use moderate profile and high profile implants in select individuals that this would be a better "fit" for to meet their size expectations.

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Although there is such an entity as "too big", this is rarely the case in breast augmentation surgery.  In fact, the saying "I should have gone bigger" is also becoming a dinosaur.  The reasons: 

1. American Board of Plastic Surgery plastic surgeons take painstaking efforts to try to size the implants to fit your body characteristics and your wishes.  Often we have several preoperative consultations to very accurately determine what implant size is right for you.

2.  Implant availability.  Breast implant manufacturers have greatly increased the number of implant size and shape (projection) choices so that we may much more accurately match your implants to your needs.

Placement of the implant behind the muscle will somewhat decrease its projection, but volume is volume and once the muscle relaxes after the surgery the compression effect of the muscle will be less visible.  However, your dilemma about 350cc vs 300-325cc may be unnecessary anxiety.  Neither of those differences (25 or 50cc) is likely to change your cup size.  Additionally, since bras are not all cut the same, some bra cuts may give you a C cup and a different cut bra may result in you needing a D.  The bottom line is, if the breast is in balance with the rest of your body habitus it will look great whether its a C or a D.

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The volume is obviously the same, but as the breast settle into their pocket, the implant may appear somewhat smaller than the size you initially thought you had immediately after surgery.

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