Want 180cc. Why Do Many Plastic Surgeons Push for More?

The more breast surgery I do the more I realize that there is no correlation between the size of implant and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saiine/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.  
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. 

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.

It isn't a matter of preference for larger implants, but when you are trying to avoid a lift with implants they have to be large enough to fill up the loose skin. For an athletic build and lifestyle smaller is usually better, but they have to do what you want them to.

Hello Miss L,

I am in agreement with you that a small implant would be appropriate for your size because of your short stature and already full breast volume.  However, you are under the unfortunate misconception that an implant can RELIABLY  lift your breast.  Breast augmentation is not a replacement for a breast lift,  regardless of the size of the implant!

Women's perception of breast sagginess varies, and includes seeing tissue hang below the crease under your breast (the inframammary crease or fold), the position of the nipple on the breast mound, or the fullness (or lack there of) of the breast above the nipple.  Plastic surgeons have a system to categorize breast sagginess to determine the best remedy.

Breast implants can re-volumize the breast reliably, bringing fullness back to all areas, including the upper portions.  If the nipple is sitting well above the inframmamary crease, then it too can get a small lift in postion.  However, the opposite is true if your nipple was hanging below your crease prior to surgery, and it can even begin to point downward as it the implant pushes the upper part of the nipple out and down.  Ever larger implants will not remedy this problem either; in fact, it become less and less likely the larger implant can make the nipple 'rotate' up on the mound as that mound becomes bigger.

Your photos do not allow assessment of the true shape of your breasts, the position of the nipple, or the shape of the bottom of your breasts, nor have you described what it is you'd like to see changed with your breasts, so I can not comment on your personal situation.  My recommendation is to see a few very experienced breast surgeons who are all certified by the American Board of Plastic Surgery.  If they recommend a breast lift (with or without an implant) to give you the look that you were envisioning, but you don't want a lift, then you should consider not having any surgery at all.

Best of luck!