Do doctors choose implants size only based on BWD, or patient's wish size? (Photo)

I am 5"2,100lbs,BWD 10.6,wish C cup.My doc suggested Natrella tear drop MF 195cc( bwd 10.5 ) and MX 255cc (BWD 11 ).I told him I wanted silicone round 240CC (BWD 11) or 255CC. He answered he would NOT do it for me cause over my BWD( just over 0.4). Then why he could choose tear drop implant 255CC which BWD is 11. But not silicone moderate 240CC which BWD also 11? He replied me round shape implant as long as it's BWD over a bit won't fit in my cheast. Is that true ? I had to end up with Sil 210c

Doctor Answers 7

What size breast implant can I have?

I sit down and listen to my patients as to what they want and then after examining them. discuss the various alternatives such as size and let the patient decide what they want. 


Newport Beach Plastic Surgeon
4.4 out of 5 stars 27 reviews

Breast Implants

Hi Cherry, yes, we would favor a round, gel, high profile for you based on what you are writing to get you to a C cup based on your wish boob photo.  Keep your PS in the loop, however.  Here are of our general thoughts on sizing because this is perhaps the hardest decision for a patient to make, as well as the surgeon.  Also see the video attached to my answer.  We spend up to two hours for our BA consults to be sure there is careful communication. We do a full exam in front of a full-length mirror taking six exact measurements.    We put your photos on a large computer screen for imaging, and go over your “ideal-size” photos. We then save this information to your password protected “web account.”


     First and foremost the implant should fit the dimensions of your breast and tissue cover.  Balancing the implant to your over-all body shape and tissue cover is essential.    The main thing is to have the diameter of the implant fit the diameter of your breast "foot-print".  Higher profile implants tend to have a smaller diameter.  Higher is really a marketing term, but often translates into the same volume implant with a narrower base.  Saline implants actually tend to decrease in diameter as they are inflated!  The average size chosen over our last 7,000 breast implants was “350cc”.  BUT, 90% of our patients tell us they wish they were bigger a year after BA.  (We will see you every year for routine checks at no charge.) It’s like your mind incorporates the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc.  You can try on implants in the office by placing them into a special bra.  The implant is also flattened somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for flattening of the implant in the partial sub-muscular pocket.  Once you decide on a size you like, then add on 25cc, because in real life the implant will be flattened slightly by your tissues.  Multiple measurements need to be taken to fit an implant to your exact anatomy.  Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer.  Then you and your surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan.  Keep in mind larger implants tend to have more problems over the years.  Since silicone implants wrinkle less than saline implants, they might be your best bet.


     You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra.  Wear this around the house for a while, and see what you think.  Implant size must square with assessments of tissue cover, breast diameter, and chest wall width.  Multiple measurements of your chest wall are taken (seven in total).  Implant size selection has been an issue of much discussion.


     Therefore, I use a wide variety of methods, but the implant size is always established preoperatively.  Also, patients are advised to bring reference photos demonstrating their ideal size and shape.  A photo album of patient pictures is maintained to assist them.  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.  Finally, your verbal requests are factored into the analysis.


     We use the quick-recovery approach, so click on the web reference link below to have this explained and you can see the list of Quick-Recovery (Flash-Recovery or Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery journals.  It is a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs. It causes far less trauma to surrounding tissue than traditional approaches, and it dramatically reduces pain and recovery time. In published studies of BA patients, 95-percent of women interviewed after the procedure returned to normal daily activities within 24-hours. Quick-recovery BA is not a “gimmick.”  These specialized techniques, which actually speed recovery and get you back to your daily routine, kids and work, are published in our plastic surgery journals.  Because these PS journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science. Therefore, these are sound techniques, not marketing hype. 


     Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons).  Also, ask if the PS has an established, high volume breast augmentation practice, performing several hundred breast augmentations each year.  Be sure the PS has been in practice for a while, about 20-years might be a good gauge.  Does the PS offer all three incisions?  Discuss the implant type (gel or saline), shaped "gummy bear" or non-shaped, smooth or textured, implant pocket (over or under the muscle) and the "quick-recovery approach."  Ask to see their before and after photos if you didn’t see any on their website.  If they are experienced, they should have several 100 breast implant patients for you to view.  I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you.  You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center.  Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.      


All the best, “Dr. Joe”


 


 


Implant size

there are many different ways surgeon choose implant size.  I rely on my experience along with the patients build and wishes regarding their size goals.  I think your result is nice, but the size selection was conservative in my opinion.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 25 reviews

Tissue Based Implant Selection

Hello,

Your surgeon is trying to save you from complications and reoperation. You are clearly in the early phases of healing and will 'drop and fluff' over time. BWD is one of many potential measurements. I believe his primary concern was rippling, and teardrop implants ripple less than round smooth implants due to their more cohesive gel. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Do doctors choose implants size only based on BWD, or patient's wish size?

Thank you for the question.  There are no hard and fast rules when it comes to diameter of breast implant versus diameter of breast (band width). In other words, these measurements are useful but are only one of the many factors come into play when it comes to selection of appropriate breast implant size/profile.


Ultimately, careful communication of goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) are critical.


 

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:


1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.


2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.



3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link/video, dedicated to breast augmentation surgery concerns) helps. 

Size

Thank you for the question and first and foremost I try to give patients their desired volume assuming their measurements and skin elasticity will allow it.  I want my patients to be informed of the risks and benefits of their volume choices though.


Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 60 reviews

Implant selection - based on breast dimensions or patient's wish size?

Hello, doctors choose implants on both factors - the person's anatomy including BWD as well as their goals and expectations.  It is obviously very important to consider what the patient wants for the final size, but ultimately their body will limit the size of implant that can be inserted safely.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.