Why Can't my Surgeon Choose my Implants?

I have been to 2 consultation visits with 2 different Surgeons. I became confused when I was handed implants and was told to choose one by placing them in a bra. I couldn't tell. I can choose a photo of a woman and say I would like something similar to that size. I am a hairdresser, and to me it would be like a patron wanting me to curl their hair and I hand them a box of rollers and say "choose which ones you want me to use". Am I wrong?

Doctor Answers (20)

Who should choose your breast implants?

+4

The surgeon should choose your breast implant size.  Obviously your board certified plastic surgeon will need a lot of input from you.  She/he might need to ask some vague and probing questions to get a feel of what would work for you.  The natural look,fake, like my girlfriend, I want people to notice a little or a lot, like this picture etc.  These are some of the statements that help a surgeon decide what is right for you.  The days of the surgeon just picking a size and saying this is perfect for you might work for some.  But most of the educated patients know what they want and the sophisticated surgeon needs to tease that out of you. 

 

Good luck and thank you for the question.

 

Sincerely,

 

Anire Okpaku MD


Miami Plastic Surgeon
4.5 out of 5 stars 25 reviews

Breast Implants-How to Chose the Right Implant for You

+2

Thank you for your question.

Your surgeon should be able to help you choose the best Breast Implant for you.

It is important for you to make the final decision but the Surgeon should assist you in understanding the different types of implants, location of incision and implant and the proper size. I agree that you should seek other opinions.

 

There is a new Mentor Breast Implant Sizing system which can be very helpful-rather than an implant a specifically designed sizer fits into your bra with a more accurate shape of the breast after surgery than just placing an implant.

The link below discusses the Rice Test-another method that you can do in the privacy of your own home.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 30 reviews

Deciding on breast implant size

+2

I would recommend consulting with other surgeons. I think the decision for breast implant size should be a collaboration between your and surgeon.  Bringing in pictures that represent your goals will help them into deciding which style and size implant is best for you.  I also like to try implants on multiple times with my patients before surgery so that everyone is comfortable and confident with the decision.  I hope this helps you.

Kindest regards,

Neil J. Zemmel

Neil J. Zemmel, MD, FACS
Midlothian Plastic Surgeon
5.0 out of 5 stars 54 reviews

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How can I tell by placing them in my bra?

+2

If you feel uncomfortable and/or uncertain With the consultation, see other surgeons, and learn from each about size selection.  Bring photos of breasts you like to the consultations.  Openly ask questions when you're not certain.  Ask the surgeon how he/she chose those two sizes.  Eventually, you will understand enough to select which are best for you.  The surgeon or assistant should provide more assistance to you, in my opinion.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 38 reviews

Why Can't my Surgeon Choose my Implants?

+2

Great question and in my mind the surgeon should have the major responsibility in choosing the implants. But if they leave the choice to you and you aren't happy, then of course they feel they can't be blamed. I've been doing this job for 30 years and find my patient satisfactiooon rate to be extremely high. We use the breast base diameter as a starting point and then during surgery use temporary implants called sizers until we find the exact volume that gives the closest look to what the patient has requested, especially if they have brought in photographs of the look they prefer. It is a simple system, but I think many surgeons are so worried about patient dissatisfaction they prefer to pass the buck to the patient. Keep looking until you find a surgeon you feel comfortable with.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 13 reviews

Who Chooses Breast Implants?

+2

Thank you for the question.

You will find that every plastic surgeon has a different “methodology” when it comes to the selection of breast implants for breast augmentation surgery. Some surgeons ask their patients to choose the breast implants that they feel would work best for them;  my preference  is to select the breast implant size/profile myself AFTER  careful preoperative communication and the use of intraoperative sizers.  By necessity, I have the full range of saline and silicone breast implant sizes/profiles available from both major companies.

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.


Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.


I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 718 reviews

Choosing size of breast Implants with your surgeon

+1

This is a decision you and your surgeon will make together. It is important to understand that there is not a wide range of implant sizes and profiles that will look natural in each individual patient. Given your height, weight and preoperative breast profile, there really is a limited range of implants sizes and profiles that will produce a full - but natural - breast appearance. So it is important to establish from the beginning whether or not you and the surgeon that you have selected have the same aesthetic vision. One of the best ways to do this is by reviewing the surgeon's 'before and after' photos.

You can certainly purchase the size bra (unpadded) that you would like to fill out and experiment at home with bags of rice. One implant manufacturer also has a 'pre-consultation' kit with sample 'sizers' that you can use at home to get some idea of the implant size range that may work best for you. You could bring some photos to the consultation appointment of breasts that are appealing to you, and you can show your surgeon which of their 'before and after' photos are most appealing to you. There is no substitute, however, for the process of examining different implant sizes and profiles with your surgeon during your physician consultation appointment. You can hold them up in front of your breasts, and you can put them in an unpadded bra that is the size you would like to be. Your surgeon can show you how each implant's base diameter and projection will impact breast appearance. This will give you a very good idea of the result you are likely to get from each size and style.

Implant 'profile' refers to how wide an implant is (base diameter) compared to how much forward projection it has (height). The implant manufacturers use different terms to describe these profiles, but in essence there are three types: low profile (wide base diameter / modest projection), intermediate profile (less wide, more projecting) and high profile (even narrower diameter, very projecting). If the goal is a full but natural-appearing breast enhancement, almost all patients need a low- or intermediate-profile implant. A 'deflated' appearing breast with little forward projection usually looks best with a intermediate profile implant, while a more youthful-appearing breast with some natural, inherent projection often looks best with a low profile implant - especially in a slender patient with an athletic frame. There are very few patients that need a high profile implant, at least not if the goal of surgery is a natural-appearing breast enhancement. The combination of narrow base diameter and high projection is really an implant style that is more suited to breast reconstruction than breast augmentation.

Ultimately, you will have to put your faith and trust in the surgeon you have selected. Communication is key, so be certain that you and your surgeon have the same idea of what a beautiful breast looks like. And make sure that your surgeon takes the time and effort in the operating room to use sterile breast implant 'sizers' to determine the implant size and profile that is ideal for you personally. A good breast augmentation surgeon goes into the O.R. with a good idea of what implant size and profile will work best for a patient, but makes the final decision using implant sizers. Breasts are often asymmetrical in size and shape, and the chest wall may also be asymmetrical in terms of its forward projection on each side, so in some cases a surgeon may need to use implants of different size and/or projection. The only way for a plastic surgeon to ensure that a breast augmentation result is full but natural-appearing, and as close to symmetrical as possible, is to evaluate the appearance of a variety of sizers in the operating room with the OR table raised into an upright, sitting position. Your surgeon should keep a full inventory of implant sizes and profiles in the surgery center, so that the implant choice is never limited by 'what is available'.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 40 reviews

Who chooses the breast implant?

+1

You are both correct and quite perceptive. I like your example/analogy. I compare the process to choosing a shoe to fit your foot or a dress to fit your body. You don't just pick a size and make it work and you don't try it on a model or in a way that has little meaning to how it's going to fit and look on you. If it was an orthopedic implant or there was only one size available then there wouldn't be much discussion. 

The problem is that there is no reasonable way to measure the size of your breast and show you what the effect of an implant would be or what it would look like exactly after the implant is positioned behind your breast. You can't "try it on" in a meaningful sense although there is a way to measure you to determine what implant will fit and what effect that will have in general depending on the choice of forward volume (profile) of the implant.  Computer imaging is getting better at this and probably better than looking at pictures of other women but I would counsel against showing pictures of others and particularly using implants externally in a bra to judge size. You've also heard the issue of responsibility for unhappiness with the result. 

Plastic surgeons understand why you can't show a picture of someone else's nose and request that nose as your result. Breast augmentation is taking your breast and putting a pillow behind it. It's going to look like your breast filled out with volume and the issue is what effect will it have and what size will it look like. There is no simple way to show this. External sizers are not helpful as you found out and can be misleading. Experienced surgeons can guess at how big an implant will have the same effect as an external sizer but it's often a poor one from the patient's point-of-view. I also don't think it's appropriate to decide the size of the implant during the surgery for an elective, cosmetic procedure where the patient has some idea of what she would like to end up with rather than what size and type will get her hip implant function like a hip. 

Breast implants are properly sized by measuring the width of your breast and matching the diameter of the implant to it. You choose the forward profile from low to high (not always called that) and the effect, if your breast is not unusually wide or narrow for your chest diameter and if the implant is properly positioned and healed there, is to make your breast look about 1 - 2 cup sizes larger than what you started out with. Neither the beginning or the endpoint are exact. My patients choose the type of implant (saline-filled or silicone gel-filled) and the forward profile) and I make sure the width fits and it's positioned properly. This is decided before the procedure and the patient should get what she's expecting within the inexact range of breast cup sizes. 

Scott L. Replogle, MD
Denver Plastic Surgeon
4.0 out of 5 stars 1 review

Implant size

+1

Some surgeons may ask the patient to choose so you won't blame them if you are not happy with the size.  You might ask the surgeon "which size would you suggest?"  aa way of getting their opinion.  I can understand why some surgeons want you to pick the size, but patients also need some guidance and want their surgeon to lead them in a direction they will feel comfortable with.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 10 reviews

Hello

+1

In our practice we want our patients to choose there implants size because your the one that will be living with them. We usually say that 225 cc equal about one cup size. So lets say you want to be a C cup and you start with an A cup. Your implants should be in the 450 cc range. We also like to tell our patients that don't focus to much on the implant size look at your self in the mirror with the implants and try your shirts so you can visualize what you will be looking like and if you like what you see, that's the size implant you should get.

Stuart B. Kincaid, MD, FACS
San Diego Plastic Surgeon
4.5 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.