BWD vs Implant Size?

Question

I have a 12 BWD and I want to be around 285cc. With Motiva, my BWD for Mod + Profile (Demi) is 360cc, which feels too large to me. We could do 300cc at 11.5 BWD or 320 at 11.75 BWD but because I have a more natural gap near my sternum, I am worried my breasts will be seperated too much. Is that a risk of going slightly under my BWD or is this okay? I am AA with little breast tissue. Motiva subfascial is the goal so I can do overs. Otherwise, I can consider unders but I heard that makes the gap

Donovan Rosas, MD · Answer

It is important for patients to understand that augmentation will "augment" all aspects of your anatomy. The spacing of the footprints of the breast on the chest wall will vary from one individual to the next. Widely spaced breast will appear more widely spaced and vice versa. 
The spacing (cleavage) is defined by the pocket. The pocket is defined by the plane of augmentation.When placed submuscular, the medial/middle limit is the sternal origin of the muscle. Wide sternum  greater separation of the breasts  less dramatic cleavage. This space can be narrowed (with some risk of symmastia) when the devices are placed subglandular or "over" the muscle. There is no muscle obstructing a medial push, however, there is a higher risk of over-dissection and midline migration of the implant (the dreaded "uni-boob").
It is never recommended that you stray far from your unique BWD.
And remember...love the look you choose...not the cup you desire.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear Unicorn3213,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

Selecting implant size based on bwd is just a gimmick as far as I’m concerned. Also it tends to recommend an implant that is too small. Implant size should be decided based on your desires and the surgeon’s experience.  Forget the bwd. It may sound really accurate but it’s not

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them.  Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Azita Madjidi, MD, MS, FACS · Answer

Motiva implants are not available in the US so no American Board Certified plastic surgeon can give you any advice on this new implant without any experience or long term study.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not told us your bra size and have not provided photographs. If you are size 32 or 34, each 100 cc of implant corresponds to 1 cup size change. If you are size 36 or 38, each 200 cc of implant corresponds to 1 cup size change. From this, you can determine the volume required to achieve your desired goal. If you concerned about having too much of a gap then I recommend a low profile implant to fill up the gap and decrease the separation. Higher profile implants will give you a large gap, which you do not want.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ram Kalus, MD, FACS · Answer

Thank you for your detailed question. An evaluation in person by a board certified plastic surgeon is required to properly advise you. The Motiva Ergonomix is an excellent implant for subfascial placement which is my preferred plane. Please select a board certified plastic surgeon whose results appeal to you and with whom you feel confident. Best of luck to you.

Mauricio Castano, MD · Answer

Going slightly lower than your BWD is not a bad idea, this will preserve your tissue, ligaments and offer a natural result. 
The most important thing that will determine the size is the breast with and breast footprint, then the thorax curvature to see how both breast are apart or near the mid sternal line. 
Demi profile works great since they have a wide base, they help to fill out all the footprint of the breast, most of my breast augmentations are done with this profile and ergonomix type gel. 
A dual plane will not make the breast look apart (when done correctly). The most important thing is to diagnose if the thorax is very curved and this will make both breast fall wide apart with a huge gap, in this case a hybrid augmentation is recommended.

Camille Cash, MD · Answer

BWD is useful in implant selection but there is some wiggle room.  The distance between the breasts is determined by your anatomy and not influenced much by the implant.  I encourage you to return to your surgeon to further discuss the implant options.  Many have sample implants available for you to "try on" to give you an idea of how you may look after surgery.  I've included a video on this process that I hope you find helpful.

Connie Hiers, MD, FACS · Answer

The gap is due to your anatomy, and your breast bases cannot be moved. Implants behind the muscle are more restricted in filling in the gap as well because of the muscle. I suggest going with what your surgeon thinks is best since your surgeon has measured and examined you.

BWD vs Implant Size?

Answers (10)

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