Does BWD matter with small breast enhancements?

Dear Energetic448638,
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

Thanks for your inquiry, the base width of the implant matters in creating cleavage plane and fullness. As the diameter of the implant increases certain features of the breast change. That being said, your surgeon is right that the projection of the implant style is also important and small incremental changes of 2-3 mm may not be huge difference in the final result, but an 85 cc increase with a starting point of 180 cc is a 40 percent larger volume. Best of luck.

Bwd measurements are niot as accurate as you may believe. It often leads to choosing an implant that is too small. Many surgeons have either abandoned to bwd method or never used it to begin with.

In my opinion, BWD is the most important measurement with a breast augmentation. If the implant doesn't fill the breast width, the breast can be distorted (implant not wide enough) or cause a "side boob" (implant wider than BWD). A published rule of thumb by John Tebbets is that the implant width should be within a centimeter smaller than the BWD.

The width of the breasts does come into play when selecting an implant. There is a little wiggle room which is where the expertise of a board certified plastic surgeon is so important. She/He will examine your breasts and discuss your goals for surgery. That information is combined to offer potential implants that can best match your desired look. I like to use sizers during surgery to help my patients get the best fit and result.

That range of sizes should fit your frame nicely, but larger sizes would be too wide and not sit well naturally.

In my experience the decision of breast implant choice is dependent on the patient's and surgeon's goals for the operation. This decision takes into consideration the quality of the tissue, thickness of the tissue, coverage of the implant, implant location above or below the muscle, the chest wall ribcage dimension, final desired size and shape, and type of implant (saline vs gel). It is always better to have at least 2cm coverage of tissue over the implant for it to look/feel most natural. A surgeon should take the patient's desired aesthetic outcome and all these other factors to help guide implant choice/volume/position etc.

If your surgeon has experience and understands your goals, then you should hopefully have confidence in their skills and decisions with you.

Larger implants that are heavier and require dissecting or damaging natural tissue planes to fit the larger /wider volume are where base width becomes most critical in my experience for long term aesthetic outcomes. Wider implants can become problematic if it extends beyond the natural breast/chest wall width resulting in less coverage/support.

Best to clarify your concerns with your surgeon.
Take care,
Dr Rockwell