Why do some surgeons limit your implant size while others do not?

Question

Hi there. I did several consults for breast augmentation. All were with board-certified plastic surgeons. What I found is that about 75% of surgeons will limit you to implant size, based on your measurements and especially "base width" while others will essentially say "I will do ANYTHING you want. " I even had one say "I will go as big as it takes to make you happy." Is one approach better than the other?

Caner Kacmaz, MD · Answer

I understand your frustration. However, implants need to fit your frame and tissue for the best results. If you choose to go beyond the measurements and sizes right for your anatomy, there's a high risk that you will experience long-term problems like sagging, bottoming out, and thinned tissues. An implant that's too big has a higher chance of becoming displaced and malpositioned as well.  If you choose the right surgeon with plenty of experience, you can trust that he will choose the best size of implant for your body. My personal opinion is that please do not go with any surgeon who will suggest doing ANYTHING you want. Best of luck to you.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question regarding how surgeons approach implant sizing for each of his/her patients.

Obviously not every surgeon will do things the same way. As there is often more than one way to accomplish the goal/task.

In my experience, choosing an implant based on my patients specific measurements (especially the base width) is a crucial aspect when choosing the best implant for that patient.

I want the implant to fit my patient. Too narrow of an implant can cause a big gap. Too wide of an implant will make volume feel as if it is in your armpit and make you appear wider.

Hope this helps!

Leila Kasrai, MD, FRCSC · Answer

Your body determines how big you can go. So, even though a surgeon may say that they can "do anything you want”, they may need to stage the procedures. This decreases surgical risk and allows your skin to expand to accommodate a larger implant without ripping. In addition to a reduction of risks, size is limited because most patients prefer a more natural looking outcome.

Christopher Pannucci, MD, MS · Answer

Hi Anon453054,
There are several physical characteristics which help to determine optimal implant size. As you correctly note, the most important is base width, or the ideal right to left distance of the implant, as it sits on the chest wall. This measurement is inherent to you, and is not something that can be changed without negatively impacting your result. specifically, an implant whose base width is too small will not completely fill out the footprint of the breast. An implant whose base width is too wide will project into the armpit, producing the dreaded "side boob". As such, I believe surgeon should suggest an implant that fits within your appropriate base width, as a produces the best long-term result.
The choice is definitely up to you, but volume more cubic centimeters is not the only determining factor that your surgeon should used to make a decision with you on what is the best implant for your augmentation.
Breast augmentation is a custom decision that mailed your size goals with your body type. Clearly, it is individualized to you and your goals.
Hope this helps.
Best,
Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Irena Karanetz, MD · Answer

Hello,
Thank you for the question. 
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on your desires, as well as breast and soft tissue dimensions of your chest wall. I also utilize Vectra 3D planning to further help with implant selection. 
Ideally, the breast implant size should fit the chest wall dimensions for the most natural-looking and proportionate results.
I would seek an in-person evaluation by the Board-Certified Plastic Surgeon, in order to discuss your goals and concerns for the best cosmetic results. 
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Gerald Minniti, MD, FACS · Answer

The data are very clear: inappropriate implant size is the source of most complications and reoperations. Thank goodness 75% of your surgeons put the brakes on the size. The other 25% don't care, and figure a reoperation is more money in their pocket?

Albert Ko, MD · Answer

Hi there, limitations on breast implant size can be for a number of reasons, like patients preference of size or most importantly due to specific anatomic characteristics such as:
1. The breast skin envelope (available breast skin) The amount of skin in the breast can affect the size of the breast implant that is best suited for an individual patient. If there is a large surplus of skin, then a larger implant can usually be placed. If there is not a surplus of available skin, you run risks of infection and necrosis when stretching skin too tight to fit in a larger implant.2. Patients chest width (possible breast base width) -It is important to understand that as implant volume increases, the diameter of the breast implant also increases. The difference in diameter between a small breast implant and a large breast implant can be as much as three centimeters. A narrow base width can limit the size of the breast implant. 
Hope that helps!

Scott W. Vann, MD, FACS · Answer

It sounds like 75% of your consults have been with ethical well trained plastic surgeons that are trying  to give you good information and hopefully a great result. The other 25% sound like great salesmen but not completely honest about what is possible, what is impossible, or what is best. Be careful in who you choose. Good luck.

Ronald J. Edelson, MD · Answer

That’s exactly right. Some will do “whatever you want”. I don’t go over 500 cc’s. I know from experience that huge implants are trouble down the line. Other surgeons either have different experiences. Also I think that breast width measurement is a totally flawed way to choose implant size. Sounds very precise. It’s not

Harry T. Haramis, MD, FACS · Answer

Breast implant sizing is very individualized as there are many factors.

Patient anatomy, measurements, starting breast volume, body frame, patient desires, all must be considered. Also, tissue response during the surgery can influence what is possible.

In general, your starting frame, breast width, will determine a range of implants possible. This must be discussed thoroughly pre op with your plastic surgeon.

This can take several visits to make sure you are comfortable.

Why do some surgeons limit your implant size while others do not?

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