The number one thing I hear in my practice is, "I do not want to look fake, top heavy, etc." The vast majority of women want a "natural look." The problem is, that term is misleading. The perfect implant for your goals will look natural and beautiful, whether you go “conservative” or max out on size, and whether you choose round or teardrop shaped implants. For you to choose the right implant size and shape, there are a few things that you need to understand first. HOW IMPLANT SIZES ARE CHOSEN Imagine lying on your back and drawing a circle around your breast. If you draw a line across that circle, it will be a given length. (The length of a circle is called a “diameter”.) This is a measurement that your plastic surgeon will take. The length of this area of your chest is called the “base width diameter” (BWD). For women, the base width diameter ranges from 9.5 cm to 16.5 cm (3.75 inches to 6.5 inches). As you can see, there is a very wide range. A smooth breast implant is circular, and has the same measurement as your BWD. So if your BWD is 12 cm, that tells us that your implant cannot be more than 12 cm. It won’t fit. So the BWD determines the max size of the implant, length-wise. Then the question becomes, how much volume will this implant have? We’ve measured its length, now let’s measure how far out it will project. That projection is the Profile, which comes in low, moderate, full (high), extra full (extra high). A moderate profile will fit into most women. For the implants with more volume, high and extra high, whether they will fit depends on how much your skin can stretch. The stretchiness of the skin is based on genetic factors, weight, age, and whether you have had children. A woman who has breastfed will have looser skin. That means it can be stretched further and have room for a high profile, if that is what she wants. For the most part, the implant size and volume is limited by these two measurements: your base width diameter and how loose your skin is. It tells you how much you can max out on. As long as the breast implant is kept within these measurements, you will have a beautiful, natural look, even if you max out. The “fake,” “top heavy” or “stripper” look happens when the patient wants an implant that is bigger than her measurements. If it does not fit her body, it will look unnatural. So as long as you stay within your measurements, you do not have to worry about looking fake. DO NOT GET CONFUSED WITH TALK OF CCs When you are doing research online, looking at other women, the volume of an implant, the cc’s, cannot guide you in breast size. Here’s why . . . Think about just how wide a range you see in women’s body types, shapes, and frames. That’s why the base width diameter in women can range from 9.5 cm to 16.5 cm. A smaller implant gets filled up with less volume. It’s common sense. If your BWD is 11 cm, the high profile implant will have 265 cc’s. If your BWD is 14 cm, the high profile implant will have 605 cc’s. In other words, 265 cc’s and 605 cc’s will have the similar cup size for a difference in BWD. The cc is relative to BWD. MY SIMPLE PROCESS FOR CHOOSING THE RIGHT SHAPE AND SIZE Here's my promise to you . . . There's a simple process to help you select the right shaped implant. Whether you go with round or teardrop, you will be thrilled with your results because we followed this process. (FYI: “Teardrop,” “anatomic,” and “gummy bear implants” are all synonymous, they mean the same thing.) This is how it works. STEP 1: See your options During a consultation, I take out five breast implants and put them on a table. Before your eyes are low profile, moderate profile, high profile, extra high profile, anatomic, and saline implants. Take a moment to examine each shape and size. Notice that the difference between some of the implants are subtle. I will also measure your base width diameter and ee how much your skin can be stretched. This tells us what room we have to work with. Your implant will be that size or smaller, but no bigger. STEP 2: Tell me your beauty goals What is your goal? What look would you like to achieve? Do you want to go "conservative" with a "natural and proportionate" look? Or would you like to go "as full as possible while staying natural"? Your answer to this will determine the implant shape that appeals to you. STEP 3: See how this implant looks on your body Have you ever had a $41,000 picture taken of you? When I opened my private practice, the first thing I did was invest in a $41,000 device called the Vectra 3D. It is a must-have tool for getting patients ideal results. The Vectra takes a 3D photograph of your torso and breasts. Then, the 3D photo appears on a computer screen. On the screen, we can create accurate simulations of what your breasts will look like with different implant shapes and sizes. This will give you a realistic image of what you’ll look like after breast augmentation surgery. You can experiment with the different implant options until you find the one you are happy with. Being able to see the results with your own eyes, beforehand, is the best way to communicate your desired look with your doctor. It takes out so much guesswork, especially about breast implant shapes and volume (cc). Now here’s a fact about describing your goals: words can only take us so far. Very often, what a patient thinks, says, and truly wants are all different. You need to SEE what your implant will look like, on your unique body, to confidently say, “This is the perfect implant for me!” That’s the beauty of the Vectra. It is a visual tool that creates accurate expectations and ensures the best communication. It will cast away your doubts and fears about choosing the right implant. That’s why the Vectra is a critical investment for any practice. It is so important for giving patients results they are happy with and why, post-op, I often hear patients say, “They’re perfect. This is exactly what I wanted.” STEP 4: Select your implant shape and size On the Vectra, when we pull up simulations of your breasts with different implants, you will either like the result, or want to see a different one. There are two ways you may get caught up. For example you may be caught up between two different profiles or two sizes within the same profile. You’re not sure whether to go medium or high. Or your mind is set on high profile, but you are stuck between two sizes, 345 cc or 365 cc. If a patient is worried about 345 cc or 365 cc, I tell them that a shot glass has 40 cc. This is a good way of explaining that there really is not much of a difference. On the Vectra, you see that the differences are very subtle, nowhere near as drastic as you imagined. Finally, you point at the option on the screen and say, “That’s the one I want.” Congratulations, you have chosen the ideal breast implant for you. After the procedure, your breasts look very much like the way you saw them modeled. You are thrilled, and like many of my patients, you tell me “I’m so happy with my results. They are perfect, exactly what I wanted. I wish I did this sooner.” Note: there is an exception to this process. In the rare case that a patient has a long chest wall or "constrictive breast deformity", I would suggest considering an anatomic implant from the start. That shape will look better on this type of patient. 3 DIFFERENT EXAMPLES OF THIS PROCESS Let me cover a few examples of what going through this process can look like. Example One: The Patient Whose Taste Is Truly Conservative This patient tells me that she wants the implant to look natural and proportionate. She does not want to have a dramatic increase in cup size. Given this desired result, she will like either the round moderate profile or anatomic implant. We will then model both implants on the Vectra 3D imaging software and see which one she chooses. In this case, it turns out she really likes the anatomic look. I explain that there's about a 1% chance of a complication in which the implant can rotate and require revision. If she is ok with this, she'll go with the teardrop implant. If not, the moderate profile will meet her beauty goals. Example Two: The Patient Who Is Afraid Of Looking “Fake”, But Ends up Wanting More Volume This patient says something very similar to the first example. She wants to look natural and proportionate. She does not want a "top heavy", "fake" or "playboy look". She does, however, want an increase of "about 1 or 2 cup sizes". We model the moderate profile or the teardrop. But, it turns out, she wants more volume. At this point, I have explained to her that as long as we stay within her measurements she will have a beautiful, natural look. (A patient’s measurements are explained in more detail in an article about breast implant sizes.) Because of its shape, there is a limit to how much volume can be added to the teardrop, so, she definitely will be going with a round implant. She ends up going with a high profile implant, close to maxing out on size. She sees on the Vectra that it looks natural, but that it also has the size and fullness that really appeals to her. She's going to love them! Example Three: The Patient Who Wants To Max Out From the Start This patient tells me she wants to go as big as possible (usually while still looking natural). We choose a round implant with the maximum profile/volume that will fit her measurements. She sees the results on the Vectra 3D. She is either happy, or wants to go even bigger. If she's happy, great! We have found the perfect implant for her. If she wants to go even bigger, I have to explain that we've already seen the max implant volume that will fit her, based on her measurements. Anything more would look unnatural, and, much more importantly, would not be safe. If she is ok with that fact, we can proceed. If not, I explain to her that ethically, I cannot give her the size that she wants, so if she insists on it, she will have to see another surgeon who is willing to do that. A NOTE ON REGRETS AND SECOND-GUESSING THROUGHOUT RECOVERY If you read patient stories about their experience post-op, you’ll see things like: “If you’re happy with the size immediately after the surgery, you may be unhappy when the implants drop, because they will be smaller.” “At this stage in recovery, some patients feel regret and wish they went bigger.” Behind these statements is an idea that a patient’s thoughts and feelings about their decision change as they recover, and that this is normal. I believe this is an out-of-date way of thinking about breast augmentation. Sure, people may have alternating feelings about this big life decision, but regret should NEVER be a part of it. On RealSelf, you see so many patients tormented with uncertainty about whether they chose the right implant size or shape; they are anxious all throughout the recovery process, waiting at least 3 months to see the final result. This is a very unpleasant experience no patient should go through. A patient needs to be educated the right way, they need to have all the right expectations set up front. When this is done right, you should be happy about your breast augmentation and implant choice, from beginning to end. It’s what I expect from all my patients, that they come out of surgery happy, and they stay happy. Now that I’ve explained how the Vectra works, you can understand how the guesswork is removed from the results. Therefore, you will not be tormented by doubts and uncertainty. SUMMARY There you have it. Following my simple process, you will choose the perfect implant that meets your goals. Will you want your breast augmentation to look as natural and proportionate as possible? Or will it turn out that you are looking for a fuller look? After we decide on this together, we will see what this implant looks like on your body with a Vectra 3D simulation. You will be either happy or want to see a what a different option would look like. At the end of this process, we will have found the perfect implant for you! Therefore, both round and teardrop shaped implants are acceptable choices. What it will come down to is what you think LOOKS best on your body. And thanks to the Vectra, you will be able to see it for yourself and make a choice you feel 100% confident about. The lesson here is to rely on what you SEE (in the simulation), not on what you "think" will look best, or rules of thumb. Cut out the guesswork. Verbal communication cannot be exact when it comes to your personal preference about a specific beauty look. Thanks to modern tools, and an understanding of how to give patients the results they truly want, there is no reason why you shouldn't be able to choose the perfect implant for your body. Don't settle for anything less than ideal. I hope that answers your question on picking the right implant. It’s great that you’re doing this research. I always say that the best patients are informed patients. You might also want to research your options for breast implants. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you? A term that I use with my patients for the perfect implant is the “Pony Implant”. So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural. Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small. And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!" That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours. This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it. Thank you for reading and best of luck on your journey!