Breast Implant Sizes

Choosing the implant size
Start by looking at before and after images on the website of a plastic surgeon you are considering.  A link to my breast implant gallery is below   It is important to be confident that you share the same aesthetic sensibilities as your plastic surgeon. I have attached a link to my breast augmentation before and after gallery to give you an idea of the results that I find natural. 
In consultations I listen carefully to each patient to ensure that I clearly understand their goals for breast augmentation surgery. I have never understood the desire on the part of patients or physicians (especially physicians) to create unnaturally large breasts. I see 'before and after' photos at plastic surgery meetings and I almost always find myself asking the question: What's the `big' idea?
I view breast augmentation as more than a breast enhancement surgery. It is a total body contouring surgery, and the breast profile that one creates with implants should match a patient's overall figure. It should appear completely plausible that the breasts have not been surgically enhanced. I want for my patient's appearance to make others think "Wow - what a great figure", not "I wonder who her plastic surgeon is".
Over and over I hear patients remark, after reviewing some of our `before and after' photos, that they had no idea that a breast augmentation could look so natural. It can, and in my opinion it should. Having practiced plastic surgery in the 'breast augmentation capital of the world' (Los Angeles), and having performed hundreds of breast augmentations  a year in North Carolina for patients who are seeking a breast enhancement that looks like it actually is a natural part of their body, I have developed some fairly strong opinions about this operation.
The actual size of a breast implant, measured in cc's, is really not very descriptive of what a breast augmentation will look like, or what the cup size will be. It is all relative to the size of the breast and the size of the patient preoperatively. A tall, broad-shouldered patient with small A-cup breasts may require 450cc implants to achieve a C-cup breast volume postoperatively, while a shorter patient with medium B-cup breasts may only need a 250cc implant to achieve a C-cup breast volume.
For any patient there is obviously a range of implant volumes that would be considered natural-appearing, and a volume at which the upper pole of the breast begins to look very unnatural. While one patient may seek an augmentation that is 'perfectly natural', another may be interested in a result that is more on 'the full side of natural', and many patients do ask that the largest implant volume be selected that does not produce an unnatural fullness in the upper pole.

In addition to the correct size in terms of cc's, the ideal implant shape, placement and position on the chest all are critical to a natural looking, beautiful result. Meticulous surgeical technique and creful pre-operative surgical planning are essential. Sometimes, patients think they can find a patient with a physique like their own, have implants the same size and have a very similar result. That is often not the case. We all have seen even small implants that look unnatural because they are placed too high, too far apart, or because the ideal base diameter was not considered. Selecting the appropriate size in terms of cc's is critical. But it is just one of the factors needed to have a beautiful result from breast augmentatio surgery. 

What is more important than the size is selecting the right surgeon who has the right surgical plan, meticulous surgical technique and exemplary follow up.

The following are a few things that can distinguish some surgeons from others

1) Graduating from a top tier medical school at the top of their class.

2) Membership in Alpha Omega Alpha. This is the medical honors society. Alpha Omega Alpha is to medicine what Phi Beta Kappa is to undergraduate universities

3) Formal surgical training from prestigious medical universities. The minimum number of years of surgical training for plastic surgeons to be bord certified in five years. Some physicians have as many as ten years of formal surgical training. There simply is no substitute for stelar academic and practical surgical training.

4) Very experienced surgeons with meticulous surgical technique and natural looking outcomes will have photgraphic evidence of their work. Patients should be able to view many photos of the surgery of interest, photgraphed from three different perspectives all with similar lighting, distance from the camera and cropping

The elite experience extends beyond the surgeon to the facility, and the surgical team. You should be able to see the surgical theater and know who else will be in the OR with you during surgery. The Joint Commission (JCAHO) is an organization that provides certification to hospital OR's. The Joint Commission and AAAASF are two of the organizations that can provide certification to surgical suites. Some plastic surgeons elect to have their surgery centers dually certified.

The anesthesia experience is critical to a safe and comfortable surgical experience. A board certified anesthesiologist can administer general or MAC anesthesia. My preference is to have a board-certified anesthesiologist at the bedside of my patients for the duration of surgery.

Plastic surgeons who cater to high profile individuals who place a high value on privacy will have a private first floor entrance and exit so patients never need to be in a public lobby or elevator for pre-operative or post operative visits.

Web reference: http://www.michaellawmd.com/gallery/breastaug1.html

I start with breast examination, careful measurements (everyone is asymmetrical!), and then ask the patient what her goals are. Based on her anatomy and measurements, I can then determine if her requests can be achieved, based on my training and experience. If not, I tell her, and we try to figure out what CAN work, and how to best get CLOSE to her ideals.

The problem, of course, is determining what that size really is, which can be difficult when you have "friends" that give "advice" that you will be top-heavy or have a "stripper 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 shape--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.

Forget what such "friends" say (or at least take comments like your friend's with a truckload of salt) , and choose a size that makes you feel good about yourself. If your plastic surgeon disagrees, listen to his or her reasons--your anatomy may not accommodate your wishes. But for MOST women, the size you choose is not only possible, but perfect for you! Remember, you should never do surgery to please someone else, or to try to conform to someone else's opinion.

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.

Use as many ways as needed to let your surgeon know just how you would like to look, then trust your surgeon's expertise to get as close to that look as your breast anatomy allows.

Web reference: http://www.mpsmn.com/html/implants-choosing.html#size

Thank you for your important question. There are several options to help you with your decision:

• The Rice Test- This involves placing measured amounts of Rice into a plastic bag and inserting it into your bra-you can do this at home and this test gives you the most accurate idea of how you will look with varying amount of Breast Implant volume-see link at end of article on how to do this test
• Visit Manufacturer's websites like Loveyourlookdotcom where yiou will find Before and After Photos of Breast Augmentation of most all sizes in women of various shapes and sizes
• Try different sizes Breast Implants in your bra at your doctors office-this is the least reliable method
• Talk to friends who have had the operation and ask them to share their experience

Be sure to check the article I wrote on this on Realself and be sure to check the link below

Web reference: http://drseckel.com/boston-breast-implants/boston-breast-augmentation-how-to-choose-size-of-breast-implant/

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

There definitely is a rule of thumb for choosing the right size implants.  Choose the size that makes you feel how you imagined you would feel if your breasts were always the size you wanted.  Sounds simple, simplistic?

Let's see what the process is for deciding what implant suits you. This is going to be a decision with long-lasting consequences and you want to avoid a re-operation just because you have found out after surgery that the size as not right for you. In the Mentor core study, at 3 years nearly 15% of re-operations were done for change of size or style).  We want to avoid this.

First recognize that every woman is different in how she sees herself, and what is too small for one woman may be too large for another.  When a woman first starts trying on gel implant sizers in the appropriately sized bra, she may be quite startled and even anxious about the difference.  This is common.  After a few minutes, the idea that this can actually be how you will look without artificial padding seems to overcome this initial reaction.

Your surgeon is trying to be sensitive to your feelings about what will work for you. Women commonly indicate that they want something natural, that they don't want anyone to know they have had surgery, that they want to be conservative because of concerns over how they will be perceived by  family, friends or at work. But again, this is not everyone.  Some women are not "conservative". They know what they want and if it is a larger look, they know that is what they will have.  After all, this operation is for your happiness and satisfaction only.

The sizing always begins by taking measurements of your breast base width and evaluating your soft tissue envelope. These measurements set the reasonable limits for implant width. This can be done by direct measurement as I and most plastic surgeons do, or with a computer-imaging device.  I have found that the 3-D tactile and visual information that women get from using the actual implants in the form of gel implants sizers is very important.  This virtually ensures that the choice will not be too large or too small.

During the sizing process, what you tell us, as you feel more at ease, helps refine the eventual decision. Your preferences can be reviewed repeatedly by you alone or with feedback from a friend, relative, spouse or significant other.  There is no rush.

For example, let us say your breast width is 12 cm. We know what size implants, both medium and high-profile will fit in that diameter (we rarely use low-profile implants).  A computer-imaging device would show the same information.

We know from what you have told us so far which direction you are leaning, more conservative, less conservative.  We encourage you to bring to the consultation several different items of clothing so you can see how you look in the clothes you usually wear.

Based on all this initial input, one implant size would be chosen to begin with.  Sometimes the patient says it is the perfect size.  But we know that sometimes when we give you the opportunity to try one "a little larger" that you may not see much difference and say that this one is "perfect" too. This process gives you the chance to try out how an implant looks and feels with no pressure whatsoever.  A little bigger, a little smaller, until you know very well what implant size is just "too big" and which is "too small".

Most women will narrow the size down to 1-2 sizes fairly quickly.  They then have the opportunity to go home, think about it and look at the cell phone pictures that they may have taken to review or show someone close to them.  If a woman has a moderate amount of breast tissue, we always tell her that there can be perhaps 10% loss of volume after a year, from the effect of the implant on overlying breast tissue. There seems to be a small degree of thinning of the overlying breast/skin envelope.  Since 10% of an implant in the 250-400 cc range is about the same as the difference between two sizes, this information sometimes makes a woman feel a little bit more comfortable in choosing the larger of their two choices, slightly bigger rather than slightly smaller.

Two groups of women who seem to have the most difficulty in choosing the "right" size are the women who are very afraid of being too large and those who want to be quite large. The former tend to want implants in the 180 to 250 cc range.  These are the smaller implants and are often chosen by slim or athletic women who definitely want to look natural and not be seen as having had breast augmentation. They are usually happy with the results, but in my experience are more likely after the surgery and living for some time with the implants, to feel that they should have gone bigger, or request re-augmentation with larger implants.

Women who are comfortable with the larger sizes, 400-500, are usually very comfortable with their choices. However I have noted that women in this group are also more likely after surgery to wish they had had a larger implant.  It is important to realize that trying to place an implant that is wider than the internal breast base diameter is more likely to lead to stretching of the skin, numbness and eventual re-operation.  Therefore, it is not recommended. Sometimes women who request a "D" cup find that they could have gone even larger.  Since we never want to make someone larger than they wanted (a great source of unhappiness), we have to spend more time and more than one sizing session before coming up with the final decision.

If an implant that fits the base diameter is smaller than preferred, then the patient can see if she likes the look of the high-profile implant.  A high-profile implants allows more volume in the same diameter than a moderate-profile implant.  For example, instead of a 350 cc implant, the same width might accommodate an implant that is 450 or more.  The difference is that the high-profile implant will not come out so far at the sides and will project forward more.   Then, it is important to decide if the patient even likes the look of the high-profile implants. This is an individual taste, which is easily determined by trying on the different implant styles.  We offer every patient the chance to see what she thinks of the moderate and high-profile implants.  Some women immediately know that they do not like the look of high-profile implants, while some women find they prefer them.

In summary, whether the sizing is done by computer or by use of sizing implants, if a woman has the chance to both see and feel the implants, and feel that she is in control of the process, the outcome will be good. If there is uncertainty, particularly a lot of uncertainty, then it is time to step back and use the information gained in this sizing process to re-evaluate what one really wants.  Sometimes, after sizing the patient becomes very energized and enthusiastic, and sometimes she needs to stop and think for some time. In the end, by giving yourself time to adjust to the potential new image, you are likely to be happy and not to have regrets about your size choice.  The doctor and staff can help, but should be non-judgmental and supportive, and not try to influence you or try to make your decision for you.

 

Web reference: http://www.enhanced-you.com/breastsurgery/breast-augmentation/

Choosing your new breast size is an important decision and can be stressful, but many women find it to be the most exciting part of preparing for breast augmentation. You will choose your new size with the help and guidance of your plastic surgeon. Think carefully about your goals and experiment with different sizes to find the one that's right for you.

The rice test is a good way to begin educating yourself about breast augmentation sizing and prepare for your consultation with a plastic surgeon. At this meeting, you will discuss your size goals, "try on" different sizes and decide if you want to proceed with surgery. Bring to the consultation anything that will give the surgeon an idea of your size goal, including photos, your notes from the rice test and bras you might like to wear. If you decide to go ahead with breast augmentation surgery, you will probably finalize your size decision at a pre-op appointment.

Rice Test

To do the rice test:

1. Cut a 12-inch length of pantyhose and tie a knot in one end.
2. Fill according to the chart below (in cups) to simulate breast implant volumes (in cc's).
3. Wear the "rice implants" inside a sports bra.
4. Start thinking about your size goal.

You can begin to get a rough idea of how you might look with breast implants by doing the rice test. Using bags of rice worn inside a sports bra, you can "try on" different sizes very quickly and become educated about fill volume measurements in cubic centimeters (cc's) prior to discussing size with your plastic surgeon. You may want to use bras in several different sizes to experiment with and to simulate how you may look and feel at different sizes.

To make your "homemade" breast implants, cut a 12-inch length of pantyhose (don't use the foot portion) and tie a knot in one end. Then, fill the length with rice according to the chart below to simulate breast implants of various sizes. To try a different size, pour the rice back into the measuring cup and re-measure. Ziploc bags can be used instead of stockings, though stockings are usually more comfortable and conform more easily into shape when placed inside the bra. Different fillers can also be used, including water, instant mashed potatoes and oatmeal.

Amount of Rice
(cups) Implant Volume Simulated
(cubic centimeters)
0.53 cup 125 cc
0.63 cup 150 cc
0.74 cup 175 cc
0.85 cup 200 cc
0.95 cup 225 cc
1.06 cups 250 cc
1.16 cups 275 cc
1.27 cups 300 cc
1.37 cups 325 cc
1.48 cups 350 cc
1.59 cups 375 cc
1.8 cups 425 cc
2.01 cups 475 cc
2.22 cups 525 cc
2.43 cups 575 cc
2.64 cups 625 cc
2.96 cups 700 cc

For example, to test your appearance with 350 cc breast implants, fill your stocking with just under 1 1/2 cups of rice.

Once you have prepared your "rice implants," try on different shirts, blouses and bathing suit tops and look at yourself in the mirror. Wear them around the house, to the gym, to run errands and see how your activities are affected. Ask trusted friends, family members and your significant other for their opinions. Think about how you would look and feel with breast implants of various sizes. Take notes throughout the test and take them along if you decide to see a plastic surgeon.

The rice test is valuable as a fast and easy way to approximate your appearance with various implant sizes. Just remember that it is only a general guide for sizing and should be considered mainly as a way to begin educating yourself and prepare for your consultation with a plastic surgeon.

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.

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.

For breast implant sizing , it comes down to  5 key  elements for the highest patient satisfaction and least revision rate in my experience   They are listed in the order of importance for my practice:

1. Patient Choice-  The overall goal is to help your patients find the best size for them that looks natural not fake .  For most patients, this means a round smooth implant-saline or sillicone -below the pectoralis muscle .  I listen carefully to what my patients want .

2 Surgeon's Guidance- Our role is to help guide the patient to the correct implant size, shape and type based upon what she wants to look like with and without clothes.  This is best done using a set of photos which the patient is requested to bring, or they can go to  my website-drrohrich.com , or  we provide a set of photos in the office to show all the different types of implant shapes and sizes . 

They can go also  to an  implant site like implantinfo.com to help them choose a size or shape . This along with the chest wall measurements allow me to give a patient the best advice on what will look best on them .  I DO NOT FIND THAT STUFFING IMPLANTS INTO A BRA IS VERY HELPFUL AS IT MAY BE QUITE DECEPTIVE AS TO THE FINAL SHAPE AND SIZE NEEDED.

3. Chest Wall Measurements- This is very important to help guide the patient to the correct size and shape as well as the amount of breast tissue and skin envelope the patient has as this will determine what size will look the best.on her long term.   This wil also help decide whether the patient would look better with a saline or silcone implant .

4. Pre- Op Photos- I find this very helpful to gain a true understanding of what the patient means when she says -" I want to be a C Cup ".  As we all know, the Cup size is so variable that it is not useful.  A  set of photos which is from the patient is invaluable in helping both the surgeon and the patient  be on the same page for the ultimate sizing for the patient

5 Intra-Op Sizing/Refinments- This is this final refinment needed intraop to detect any subtle dicrepancies to acheive the best result for the patient .  I routinely place sizers and sit the patient upright intraop .  Although, I has already used the correct size of implant in over 90% of patients intraop without this final technique,  this does help further define a good result .