Breast width - how close to your base width do doctors like to stay?

Question

Hello. I am looking to get a breast augmentation and want to go large with the highest profile I can. I like the augmented look. My base width is 14cm and I have lots of tissue but I am older (thinner skin) and have had a previous implants (375cc moderate profile) then removed at which time I got a lift. My question is how close to your base width do doctors like to stay? Is it within 1cm? Because I see with some implants that would mean I would need to go EXTREMELY large (high cc) to get my base with and I worry about added complications that would bring as well as physical looks. I want big but not CRAZY large!

Daniel Barrett, MD · Answer

Dear 81818181,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gary DeCesare, MD · Answer

Ideally, your implant would match your base width. In certain cases, some surgeons will go up 1 cm and rarely even 2 cm from the base width in very specific circumstances if the patient wants more volume than the maximum projecting implant at their actual base width will allow. If you are asking about getting a smaller base width implant so that you can have a maximum projection implant without high volumes, than this would generally be advised against. Put simply, you wouldn't want to build your house on a narrow foundation.

Ira H. Rex III, MD · Answer

Since you had 375 cc implants in the past, you can probably use this as a good indication of what your new implants would be.  Do  you want them larger?  To get up to a 14 cm base, you may need a 575 cc implant.  This is quite large, as you know.  I think it is more helpful to think about the overall volume you want.  It will probably sit on her chest wall and look just fine.  Yes, the 1 cm difference is talked about, but might not be important to your situation.

Michael A. Fallucco, MD, FACS · Answer

Thank you for your question—it’s a thoughtful one and shows you’ve done your research. When selecting an implant, especially in a revision case like yours with previous implants, a lift, and thinner skin due to age, surgeons generally aim to stay close to your natural base width to ensure a balanced, aesthetic result and minimize complications. Typically, most surgeons prefer to stay within about 1 cm of your base width, but this can vary depending on your anatomy, skin quality, and desired look. Since your base width is 14 cm, choosing a high or ultra-high profile implant can give you more projection without excessively increasing width, helping to achieve that augmented, fuller look you like. However, going too large in volume to max out width may introduce risks like skin stretching, rippling, or bottoming out—especially in cases with thinner tissue or previous surgeries. It’s possible to achieve a dramatic but tasteful result without going to extremes, and a good plastic surgeon will help balance your aesthetic goals with what's structurally safe and sustainable for your body long-term.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice for over 30 years and breast surgery and revision breast surgery is a large portion of my practice.  I have never felt that breast with measurements were really that helpful.  In fact, I recently wrote a an editorial in our journal regarding wide chest walls with narrow breast implant obtaining optimal results. Very often, I will place an Ultrahigh profile implant that may be 2 or even 3 cm more narrow than the chest width and have an excellent result.  Do not get trapped with the breast width dictating the implant size. You can have an ultra high-profile look without going to big, for sure.  Best wishes to you.

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., USA

Donovan Rosas, MD · Answer

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing.  Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.  
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
With regards to your specific question, I will typically try to avoid exceeding measured base width by more than 1 cm.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." Communication is key as you and your surgeon create your custom surgical plan. 
As always, discuss your concerns with a board certified plastic surgeon.

Tuan A Truong, MD, FACS · Answer

Thank you for your question! Most plastic surgeons will stay reasonably close to your breast width. However, various other factors will come into play when selecting an implant, such as skin quality, amount of breast tissue, skin stretch, implant profile, etc to obtain an "augmented look." Going over these concerns with your plastic surgeon will help optimize your results. Best of luck in your journey!

Camille Cash, MD · Answer

Base width is just one of the factors used when determining implant recommendations.  I encourage you to begin with the look you are wanting.  Your board certified plastic surgeon can combine that information with other factors such your breast width to give you a range of volumes and profiles to consider.  I like to use sizers during surgery to help my patients achieve the look they are wanting.  I've included a video on this that I hope you find helpful.

Mats Hagstrom, MD (license on probation) · Answer

Each surgeon will have their own way of making these decisions.
Likewise, each surgeon will have their own way of guiding patience through the implant selection process guide
Some plastic surgeons will ask the patient to make the final decision regarding implants.
Other plastic surgeons will make the decision based on input from the patient.
 The exterior breast diameter is only a reference number.
My personal approach has been to work with before and after pictures to get a clear understanding of what the patient is hoping to achieve.
Once I know what the ideal outcome is I bring those pictures with me to the operating room and use them as a reference.
 During surgery, I use temporary implant size to determine what size and shape implant won’t give the desired outcome.
I tried to leave certain tissue layers intact when creating the implant pocket.
If a patient wants an aggressive augmentation, then I will most likely use high profile implants.
If they want a more modest augmentation, I generally use low profile implants.
My choice is to work with low profile implants, but if these don’t fit the breast diameter based on the volume, the patient wants then I need to switch to higher profile implants.
I typically have a full collection of implants available to me during surgery.
This requires either maintaining an implant inventory or sending back all the implants, not used.
As I mentioned, each plastic surgeon will have their own way of doing this.
Some people do it better than others.
Finally, anytime, excessively large implants are used the chance of undesirable side effects, complications and need for revision surgery will always go up.
The bigger the implant the more likely the patient is to have problems.
Best,
Mats Hagstrom MD

Breast width - how close to your base width do doctors like to stay?

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