Breast Augmentation: What Size Implant Should I Choose?

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Motivation for Seeking Breast Enlargement: 
Some women who come in for a consultation to increase their breast size are concerned that others might perceive them as being vain, shallow or exaggerating their sexuality. If you are preoccupied by your appearance and find yourself stuffing your bra, buying heavily padded bras or your disparity in proportion causes you to buy bathing suit tops much smaller than the bottoms, and this bothers you, then breast augmentation is a healthy reason for aesthetic intervention.

Despite my experience and aesthetic judgment, asking me to define “the perfect breast” and the perfect breast size, is not only misleading, it assumes I can make a unilateral decision on the patient’s behalf. 
Certainly shape, size, position and proportion are important, but my patients have taught me my point of view is not necessarily their perception. Having said that, in general a woman’s profile should present a gentle curve with rounding from the nipple to the chest wall—not down or out, but up. Facing the mirror with arms down, the breast should start at the armpit then subtly extend outward touching the bicep with the nipple positioned slightly upward and roundness evident beneath the nipple in a smooth curve. Size is very subjective, but should ultimately be proportional. While I am confident in my surgical and aesthetic opinions, my recommendations are always tempered by the patient’s desires and goals. 
For instance, some physicians make the mistake of evaluating the ideal shape by looking at the patient through their own eyes versus hearing that patient simply wants to see cleavage when looking down at her breasts.  Over the past 25 years of performing breast augmentation procedures I have developed an approach that my patients have found beneficial in helping them decide what an appropriate augmentation goal should be for them:

  • General questions for the patient:


    • What is your activity level: scale of 1-10:  1=couch potato,  10= marathon runner
    • If she has children:  During your pregnancy, what cup size did you enlarge too and did you like that size?
    • You are on a date with other couples. Would you mind if the males in your party are thinking,  “I think she may have been augmented” or would you rather them think, “She must be working out; she looks more fit” or “That sweater sure does fit her nice.” Most of my patients would prefer the latter two choices.
  • My examination always includes: current BRA size; height, weight, shoulder width, clavicle to nipple distance, any signs of breast sagging, chest wall shape, and any asymmetry.
  • Simulation of the Breast Enlargement: Relative to the above findings, I select a range of different sized implants that I feel may be appropriate. These choices are then placed into the patient’s bra and the size enhancement is then noted by the patient. I often suggest that a selfie of each size is taken so that, if she desires, her significant other can review the various enhancement choices.

Determination of Anticipated Breast Implant Size: after a review and assessment of the above finding, the patient and I can now narrow our choice of breast implant size down to within a 50 cc range (1 coffee cup size).  If the patient is extremely active, then I might suggest that we reduce the final implant size by 20%. The patient can later review her photos and still have the flexibility of knowing that she can change her desired implant size upon the day of surgery. The general range of breast enlargement relative to the patient’s height, in the 1,500 breast enlargements that I have performed, are as follows:

  • 5 ft. 340 to 370cc
  • 5’4” 370 to 420cc
  • 5’8” and above 400cc to 480cc

The Goal of Breast Enlargement Surgery: “The idea is for you to be comfortable in your own skin and confident. Being self-conscious defeats the entire proposition. You don’t want others to be preoccupied with your chest. You do want them to leave with the impression that you look great.”

Implant Types: A discussion of implant types is beyond the scope of this post but other articles and blog posts will offer my recommendations.

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Eau Claire Plastic Surgeon