Why is BWD used as a limiter for implant size?

Rippling, overexpanded skin/tissue, implant malposition/dropout, double bubble, and symmastia are just a few reasons to listen to your doctor that seems 'too strict'.

Dear orange0324,
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

Thank you for your question. A large portion of my practice is dedicated to breast surgery and revision breast surgery. I have never advocated strict adherence to BWD. There is so many different factors that go into sizing of breast than just the breast width. The amount of breast tissue, the shape of the breast, the stretchability of the skin, and the density of the breast tissues all impact the overall shape and size of the breast. There are definitely those surgeons that are myopic and use BWD really performing an artistic breast surgery. I hope this helps, and Best wishes to you.

BWD is one consideration when selecting the correct implant for a patient. There are exceptions to every rule, but the surgeon must balance the outcome the patient wants with the risks and benefits of different volumes, projections, and implant styles that are available. I encourage you to ask questions if you are unsure of your surgeon's perspective. It is important that you feel comfortable and confident in your surgical plan.

If an implant is used that is wider than your natural base, a step off might be felt or seen where the implant sits outside of the breast, especially in thin tissue. Sometimes, the implant may even wrinkle and not sit properly in place. Fat transfers can be added to help decrease a wide gap or add more side tissue.

Hello orange0324
Exceeding BWD comes up with complication risks and obvious breast implants edges in long term. If you are looking for natural results i always suggest my patients to respect anatomical limitations. But if you are looking for more attractive appearance your implant choice can exceed BWD but you should be aware of the risks that you are taking.
On the other hand implant projection is important. For example if your BWD is suitable for 300cc high profile implant, you can still choose 30-50cc bigger implant with larger volume in extra high profile implants which has same base diameter but more projection.

Every surgeon has their own guidelines. I routinely exceed BWD depending on each patients anatomy. I order several sized implants (after deciding on the shape first) and use sizers (balloons) intraoperatively to determine which implant most closely resembles the patients wish pics.