How to choose correct implant size

Hi Faye.  I am glad you asked this question because it is the key to whether or not you will be happy with your result.  First, if the implant size and dimensions are in proportion to your frame, it will look natural and not like a stripper.  For any particular body frame, there are several implant styles, with varying sizes and proportions, that will fit that frame.  So, you will have several different choices that will fit you, some will be slightly larger and some slightly smaller.  This is where communication between you and your surgeon becomes critical.  The visual look that you want needs to be communicated to your surgeon.  My office asks all our patients to bring in pictures of breast sizes and proprotions that both appeal and don't appeal to the patient.  This helps me understand your aesthetic sense and is a valuable means of communication.  In the office, after taking your measurements to find the implants that will fit your frame, we then try on different implants to see which ones you like.  We look at them in a bra and with different types of tops on to make sure they look good in the clothes your wear.  We usually do these "sizing" visits 2 or 3 times, making sure you select the same implant each time.  By going to this effort prior to surgery insures that both the patient and I are very happy with the results.  I also remind my patients and friends that the only people we know have breast implants are the ones who are "advertising" it.  There are lots of women with breast implants and you would never guess it.  Hope this helps. 

Tracy M. Pfeifer, MD, MS

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. 

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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.

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.

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