First of all, cup sizes are an inaccurate way to communicate because they vary between manufacturers. This is perhaps the hardest decision for me and the patient to make. Therefore, I use wide variety of methods, but the implant size is always established preoperatively. Patients are advised to bring reference photos demonstrating their ideal size and shape. A photo album of hundreds of past patient photos is maintained to assist them. My website has over five thousand patient photos. These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery. In determining the final size selection I always place the highest priority on the preoperative measurements and potential tissue cover. Then, the patient’s verbal requests are factored into the analysis. Cup size estimates can be misleading, as I mentioned, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc.
During consultation, patient photos were taken, transferred instantaneously to the computer with photo card, printed, and analyzed. Each patient tries on multiple sizers with a bra, under a thin t-shirt. Most preoperative consultations last about two hours. The profile of the implant - low, medium, or high - is secondary, while the implant diameter vis-à-vis the diameter of the breasts is primary. In this way, I work backward with each of the patients, beginning with an analysis of each patient’s measurements, such that the profile of the implant was determined secondarily after the size was chosen. Approximately 50 cc (1-2 oz.) is added to the final volume to account for flattening of the implant in the partial submuscular pocket. All the best, "Dr. Joe"