Unhappy With Implant Size- Doctor Made Choice Without My Consent

i had BA & requested a largeC or small D, dr made me large B, stated risks of bottoming out. Why didnt he tell me from beginning??? I didnt want small unoticeable implants. Then when i asked about enlargening them he said after 6 months its possible depening on my skin. He taped me in the center and said because i almost bottomed out. I paid 6000 for this! Is this fair practice? Does he have right to charge me for revision??? To enlarge them?

Answers (12)

Implant size too small--is this the surgeon's fault?

Now that the surgery is done, it's too late to discuss sizing, but it is clear that your surgeon and you were not on the same page. It sounds as if your surgeon is now trying to explain his "too-small" choice on the basis of the misguided belief that "bottoming-out" is caused by large(r) implants. While larger implants are indeed heavier, this can be compensated for by  a slightly higher pocket creation that allows the implants to drop into the proper position, rather than positioning them "exactly" and hoping they will stay there with a supportive bra (They usually don't, BTW.)

In reality, your surgeon just got the wrong size for your wishes. Maybe your fault for not enough discussion with the surgeon, maybe the surgeon's fault for not enough discussion with you, but probably a bit of both. But now you're stuck with implants that are too small, and it takes an operation to "fix" THIS problem. Who pays is the next question, and you should have had this answered BEFORE you asked this surgeon to operate on you.

Which, of course, you DID consent to. I'd bet you even signed what is called an informed consent form. The problem, as it usually is in cases such as this, is that CONSENT is not the issue, it is the INFORMED part.

Being angry won't increase your implant size; only your surgeon (or another one, with another cost) can do that. "Blaming" is usually not a good way to get your surgeon to do what you want, but only you know just how much you now mistrust your surgeon, or how trustworthy he seems with "excuses and explanations."

I think my colleagues who are telling you that there are limitations in anatomy that may not allow the size you wish MAY in fact be right. But truly, that IS the job of your surgeon BEFORE the surgery. And frankly, unless you are physically tiny with taut skin and hardly any breast tissue of your own, you probably can be at least close to any size you reasonably request. (Think of an obstetrician telling you that your tummy is too tiny to have a baby in there!) Nature finds a way, and surgeons can do this too, though tissue expanders or staged implant operations may be necessary in rare cases.

Usually, it just takes listening to the patient, sizing in a bra, looking at photographs of the desired size, and measuring the anatomy of the patient.

If you need to see several ABPS-certified plastic surgeons to achieve this, well, you will have to pay the piper again. If your surgeon is ABPS-certified, experienced, and still has your trust, then you need to have a detailed discussion with him. Now, and without anger or recriminations. And you need to expect to pay for OR, anesthesia, and the new implants, unless your surgeon does enough breast augmentations to get "help" from his implant representative. Or feels that it was his failure to listen that was the reason for the incorrect choice. (If he's talking about "bottoming out" as his "reason" for his choice rather than your requests, this may fall on deaf ears.) Good luck and best wishes.

Relation between Implant size, Breast size and Bra size in Breast Augmentation

The cup sizes are not standardized and are different from one manufacturer to another and different from one model to another. The volume of breast implants are measured by “cc”or “ml” and there is no correlation between cup size and “mI”. The same size implant in two different patients even with the same cup size breasts could result in completely different cup size, because there are a lot of variable such as the size and shape of the breast, shape and width of the bony chest, elasticity of soft tissue, amount of loose skin and width of the breast base. Also there are limitations as to how large an implant you can have based on the location of the implant( above or under muscle), on the amount of loose skin, elasticity of the skin and soft tissue and the width of your breast base.

It does seem like there was some breakdown in communication between you and your plastic surgeon. It is reasonable to wait 6 months before going larger to allow the tissue to stretch. Regarding the charge for the second surgery, you should work that out with your plastic surgeon, but you should understand that with any surgery there are some expenses(new implants, anesthesiologist, medical and surgical supplies, outpatient facility charge, etc.)

A. H. Nezami, MD
Jacksonville Plastic Surgeon

Unhappy with implant size

It sounds like you are having a tough time with your postoperative course.   It's not uncommon for patients to be disappointed with their breast size, and sometimes it's just a matter of waiting long enough for the healing process to occur, swelling to subside, implants to drop, and the immediate postoperative stress to resolve.  However, it may be that the communication between you and your surgeon wasn't sufficient - it's difficult to guarantee bra sizes since most women can comfortably wear a couple different band/cup sizes and not all bras are the same - and there are many reasons to not put in large implants from a technical perspective, depending on your body.   I would recommend talking with your surgeon about your concerns until you feel comfortable, or asking him to recommend another opinion!

Revision costs.

It is important for your doctor to inform you of things and for you to discuss size and options prior to surgery.  Some doctors will charge a fee for revisional surgery and others don't- it's very dependent on the surgeon.  You should read consent form that you signed before your surgery- these issues were likely discussed in that document.

Not happy with Breast Implant Size

With breast augmentation surgery, it is NOT POSSIBLE to guarantee a specific cup size or cc amount.  The surgeon has to make decisions after examining you and knowing your goals.  There are many factors involved with how large you can go during surgery.  I ask patients to bring in photos of their "desired look" because I feel that this type of communication is MUCH MORE clear than "C cup" because different sizing is different when you try on different bras.  I don't know how far out from surgery you are but allow yourself time to heal, for the implants to settle, etc. before determining that you are unhappy.  After 6 months or so, if you are still unhappy, have a discussion with your surgeon.

Too small after augmentation

Volume and skin must be in balance.  If you have a small skin envelope your surgeon may have felt limited in terms of the volume that your skin envelopes could safely (and aesthetically) accommodate.  Your surgeon should have taken time before surgery to make sure that you were on the same page.  If you are now dissatisfied the only charge for revision should be for anesthesia and surgicenter.

Daniel Greenwald, MD
Daniel Greenwald, MD
Tampa Plastic Surgeon
52 reviews

Please send your pictures

You  are not happy with the size and you are not alone. The problem is the patient expectations and the limitation of the breast tissue. I do not see any reason that your surgeon would place smaller implant than you wanted . Please send more information about your implants and your before/after pictures

Unhappy breast size after breast augmentation

Clear communication is the key to the look you want after breast augmentation, though it is the surgeon's responsibility to choose the implant size which will get you where you wish to be, yet stay out of trouble with high, bottomed out, or a 'double bubble' breast. We would like to think that you doctor placed your interest first, and you should spend more time with him to help understand where you have fallen short of your goal, and what the chances are of a safe or meaningful revision if you wish.

Best of luck,


Unhappy with Breast Size After Augmentation

I am in agreement with most plastic surgeons who believe that it is not possible to predict or promise an exact cup size because there are too many variables. Also there are limitations as to how large an implant you can have based on the amount of loose skin, elasticity of the skin and the width  of your breast base. It does seem like there has been some breakdown in communication between you and your plastic surgeon. Don't expend a lot of energy being angry. Go and talk with your surgeon again and bring pictures of the size you would like although know ahead of time that not all things are possible. See if you can work out a solution for a revision that is satisfactory. There are no set rules for charging for revisions, only what you have discussed and agreed upon. If you are still not happy, then go and get another opinion from two plastic surgeon and see if you hear anything different.

Breast Augmentation and cup size

It seems that you may have had a communication with your plastic surgeon.

Breast Augmentation surgery is not an exact science and it is difficult to predict cup size.  Bra cup sizes are not objective measurements and implant sizes will produce different cup sizes in different patients.  Every effort may be made to try to come as close as possible with preoperative and intraoperative sizers but this may still not correlate with an exact cup size request.  Have an honest discussion with your  plastic surgeon regarding these issues. 

Stephen Delia, MD
Boston Plastic Surgeon

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.

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