BWD and choosing implant size

Question

I have been measured at 11 cm BWD at surgeon 1 and 11.5 cm at surgeon 2. Surgeon 1 recommended a 365 high profile implant (BWD is 12 of that implant) Surgeon 2 recommended a 415 high profile implant (BWD is 12.5 of that implant) Lets say I truly am 11 cm - what are the risks of doing the 415cc implant? When I tried on sizers I like the look of that one more and I do have quite a large gap between my two breasts.

Finny George, MD · Answer

Hi, thank you for sharing your question. It is generally recommended that you select implants that will fit within 1-2cm of your anatomic breast boundaries. You can adjust the profile to match the volume of your choice. The risk to pushing the boundaries can result in complications down the line that will likely result in a higher rate of revision surgery.

Daniel Barrett, MD · Answer

Dear Dynamic61089,
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

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 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 is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa.,

Ronald J. Edelson, MD · Answer

Make it simple. Ignore bwd. It’s an idea that someone dreamed up about twenty years ago and it is really just a gimmick. But you have a whole generation of surgeons who were taught to do this. It often results in selecting an implant that is too small . Choose whatever size you are comfortable with

Zoran Potparic, MD · Answer

It is very difficult to give you proper advise without in person evaluation and discussion about your goals. Have in mind that you are not going to see much difference in overall size of breast within 40-50ml. of volume difference; anything around 400 ml may be appropriate? Additional corrections , in particular cleavage, can be achieved with addition of fat grafts, 6 months after implant placement, if needed. At some point you have to make that decision yourself. Hope this helps.

Jeffrey Lisiecki, MD · Answer

I don't recommend using implants that are significantly larger than your BWD.  The risk is that you are violating the natural support structures that keep your breast (and the implant) in the appropriate position, so the implant will more likely become malpositioned.  It will not make your breasts closer together, because that distance is limited by your pec muscle (if the implants are under the muscle) or the footprint of the breast (if the implants are above the muscle).  There is also no reason to do this for the sizes you want, because there are implants of that size that are within your BWD (the Sientra Xtra High Projection or Allergan Extra-Full profile implants)--up to 445cc with an implant width of 11.5cm.  Hope this helps!

Dallas Buchanan, MD · Answer

Thank you for your questions! Some photos would also be helpful as well. Measuring the BW diameter is not always an exact science as it can be done differently by different providers. However it is a good guide to keep you out of trouble. Choosing an implant larger than the BW means that a patients natural anatomy is going to get pushed past a normal appearance and that is asking for trouble usually. For example, the development of symmastia due to the implants being too wide centrally and pushing into one another. 
My best advice in terms of sizing is to decide on volume first. If you like 350cc, great, if you like 450cc, that’s ok too, just use the anatomical measurements and the volume to determine the profile you need to achieve that volume in your anatomy. If 350cc is your goal, that might put you in high profile, if 450cc is the goal, you may require and ultra-high profile implant, for example. 
You can also use 3D imaging (we use Crisalix) to have a computer program do your measurements and try on different implants within your anatomy to get an idea of how things might look after surgery. 
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Although BWD is a useful measurement to identify a relative sense of implant size that will anatomically fit, if you stay within 1-2cm of it you should be fine from a relative risk point of view.  It is more important to detail to your surgeon what your goal outcome is and they should provide you the best advice on implant profile and cc size that will best approximate it. Best wishes.

Camille Cash, MD · Answer

Breast width diameter is one factor to consider when selecting an implant, but it is not the only one.  Selecting an implant that fits the space, will look harmonious with your body, and helps you achieve your surgical objectives are all considerations.  I use sizers during breasst augmentation to help select the right implant for the patient.  I've included a video on breast implant selection that I hope you find helpful.

Douglas Taranow, DO, FACOS · Answer

I measure BWD, but do not use that measurement when deciding on which implant to use. 
I base my decisions on your anatomy and your wish pics (saying you want a certain size or look means nothing because your surgeon really has no idea what you’re saying without naked Breast  photos to assess-wish pics). 
The cleavage is based mostly on your anatomy. If your sternum is wide, you will not achieve narrow cleavage with sub muscular placement. If you go subglandular, you may risk medial rippling.
I choose the shapes implant best for your desires, then order 3-4 sizes. I use sizers (balloons) which I inflate intraoperatively to evaluate the correct size and look.  They are removed and the appropriate implant placed. 
Best wishes,
Dr. Taranow

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