Anticipated Size Not Achieved After Breast Augmentation

I had breast augmentation surgery last Tuesday. I was a 34 A and wished to be a C or D cup. My consultant advised me that it was achievable, and I would need to go for a 260cc silicone over the pectorals for a C-cup, or 300cc submuscular for a D-cup. I decided to go for the 260 cc in case I would go too large.

However, after the surgery I thought I looked rather small still. I had been professionally measured at 2 different places, and both agree that I am still only a B-cup, albeit a large B-cup. I feel really disappointed with the end result, even before it was confirmed with measurement. My partner maintains that after I've fully recovered and come the summertime, I will be happy with the end result. However, I'm so annoyed that I have had to go through all the surgery, pain, and upheaval (not to mention to be thouasands of pounds out of pocket), supposedly to make me feel so much happier with the way I look.

My partner thinks that I'll be able to put a padded push-up bra to gain the desired effect, but that's missing the point of me deciding to go through breast surgery, right? I'm meeting with a patient advisor and consultant next week. I really am not happy with the smaller than anticipated size, and do not think that I should have to put up with the size and use push-up bras to try to achieve the desired effect I was wishing to attain. How should I approach this with the consultant, and what will I be able to achieve? Would I be able to have the procedure repeated to, so I can achieve my desired full C-cup?

Doctor Answers 13

Commmunication with your plastic surgeon is essential

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Even though you are distraught and disappointed over your results, revision surgery is an option for you. Exchanging the breast implants for larger ones is not difficult and is associated with a shortened recovery time. It is advisable to wait at least 2-3 months to allow adequate healing and relaxation of the chest wall tissues. I would strongly encourage you to return to your treating plastic surgeon and discuss your concerns with him/her. Communication is essential!

There are many factors that must be considered when determining breast implant size. Admittedly, there is no precise or exact method available for us to use. Factors that must be considered include your wants and needs, body dimensions, vocation, and outside activities and hobbies. In other words, we must always individualize.

The average American woman stands 5’ 4’’ and weighs 140 lbs…you are petite. On average, 95% or more of our patients choose breast implants between 300-450 cc, or the equivalent of 10-15 oz. Keep in mind that a coke can is only 12 oz. It does not take a large volume to give you your desired look!

We always have our patients try on their implants. This is an important yet simple maneuver that is accomplished by taking various sized implants and placing them into your bra. The proper size implant should generate a feeling of comfort and ‘feel’ right!

I hope you find this helpful.

Englewood Plastic Surgeon

Breast Augmentation: wrong size

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In my experience, if a woman wears a size 36 AB bra and would like to be a C cup, which is the average size that women wear and the average size bra that is sold, she needs a volume of approximately 350 to 390 cc to make that change. This becomes less if she's wearing a 34 bra, because it has a smaller strap size and the cups have a smaller diameter. A smaller diameter implant would then be a volume of approximately 300 to 350 cc. In the same way if she was more petite, maybe a double zero or size one and wore a 32 AB bra, then to become a 32C cup she would only require about 250 to 300 cc.

Wait 3 months for implants to drop

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The bottom line is that you need to be happy with your breasts after the expense and discomfort of breast augmentation surgery, and you should not have to go to the trouble of push up bras to look the way you want to look.

It is true that you will look larger and fuller after 3 months when the implants drop and more fully distend the breast. So wait 3 months before deciding.

Generally, people who have "A cup" breasts and want a full C cup breast usually require at least a 350-375 cc implant and at least 400-450 cc is required to get to a D cup.

Express your concerns to your surgeon, but give him/her the benefit of the doubt and wait 3 months.

Did you express any concern about 'not wanting to be too large" to your surgeon before surgery? Most plastic surgeons tend to err on the large size. in my experience patients who end up feeling too small after breast augmentation have tended to influence me to go too small because they were fearful of being too large.

If this is the case then you share responsibilty for the result. I am sure your doctor wants you to be happy, and will work with you to place larger implants if you are not happy at 3 months. However, the expense of implants, OR, and anesthesia are considerable and hopefully you can work out an equitable financial arrangement with your doctor if replacement becomes necessary.

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Breast Augmentation and Size

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It's not uncommon for patients to express concern about breast size in the immediate post-operative period. Multiple factors make it impossible to assess breast size one week after surgery.

Several factors affect the size of the breasts in the immediate post-operative period. These include swelling of the breasts and surrounding tissue, muscle spasm and the healing process itself. These factors interact in a complex manner to create a rapidly evolving situation. It's virtually impossible to make decisions about breast size until the situation has stabilized.

In some cases, it may not have been possible to place a larger implant at the time of the original procedure. During surgical procedures, it's not uncommon for surgeons to make compromises to obtain the best possible aesthetic result. In some cases, utilizing larger breast implants can cause conflicts with other aesthetic goals. For instance, having large implants might create an unnatural look, which may not be desired by the patient. It may disrupt harmony, balance and proportion with other surrounding structures.

All of these concerns might place limits on implant size. In most cases, after a period of adjustment patients are happy with their breast size. Rarely, secondary procedures are necessary. For these reasons, it's important to maintain close contact with your plastic surgeon.

Breast size disappointment

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Thank you for your question. One of the most common reasons why women have breast augmentation revision surgery is to change size. It is very difficult for a plastic surgeon to commit to a certain bra size as there are wide range of bra sizes and styles out there. It is not uncommon for a woman to have different bra sizes with different bra stores/brands.
I spend a great deal of time emphasizing during the implant size selection process to try on different external sizers to narrow down the look and size they like rather than try to pick the size based on projected bra size.
At this point, if it has been several months since your surgery and you don't feel your breasts are changing much, then you can consider upsizing the implants. I would visit with your plastic surgeon so they can guide you further.

Anticipated Size Not Achieved After Breast Augmentation

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The size of the implants are based on a combination of a patient's goals and objectives and her anatomy. In order to provide a natural looking augmentation, the surgeon needs to evaluate many factors including soft tissue coverage, skin laxity, chest wall width, breast imprint width, the shape of the breasts and relative level of constriction to ensure that the breast implants are appropriate for to your body. 

Understand if there was a misunderstanding by the office of your goals and objectives. If the consultant indicates that your goals and objectives were clear, then ask the consultant if there was a failure of communication between the consultant and the surgeon. The surgeon may have determined that there was a medical reason to opt for smaller reasons which the consultant did not understand.

After you allow your body to heal which may take 6 months, then you can opt for a revision.

Unhappy cup size after breast augmentation

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If you are unhappy with the final size of your implants, you certainly should discuss this with your surgeon. Perhaps you can be revised with larger implants.

Breast implants a little too small better than a little too big.

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OK.  You are not happy with your size after breast augmentation.  Wait six months.  You may change your mind.  If not, it is pretty easy to replace with larger breast implants.

I wrote an article for RealSelf about how to pick breast implants. You can see it on my profile.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Be aware of long term changes after breast augmentation

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This is a highly personal decision that requires that you relay your desires to your plastic surgeon (or the patient advisor/consultant)so that they may help make suggestions for a breast implant size that will best fit your needs.

However, I have had some insight from taking over a practice that has been around for well over 40 years. THERE IS NO CORRECT BREAST SIZE FOR ALL SEASONS! Remember that as you age, a variety of factors will affect the size and shape of your breasts. This means what works for you now may not work for you in the future. This includes: Aging, sagging, number of preganancies, nursing/lactation, weight gain/loss, birth control pills, menopause, etc.

So although you may agonize over selecting the "right" breast implant size, please realize that this may change significantly with time and necessitate additional surgery at a later date. For example, I have treated two patients with conservatively sized breast implants (275cc) placed in their 30's who then both requested downsizing because they became self conscious when they became grandmothers and their natural breasts had become larger through menopause and the associated weight gain.

It sounds like you and your doctor didn't communicate

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As the other excellent answers have already emphasized, breast augmentation is not done with the goal being to reach a certain "cup size." This is a formula for unhappiness because there is no true standardization for cup size in the clothing industry and all patient's bodies are different.

The proper way to work out what implants will be best for you is to accurately measure your body for the best implant dimensions and then determine the "look" you want based on the profile of the implant chosen. This way, you will be getting the best implant for your body and your desires.

All of the issues you bring up should have been dealt with before surgery so you wouldn't be in the predicament you are now. You may well adjust to the implants you have but you will never be quite as happy as one would like you to be.

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.