One size bigger or one size smaller than your desired size?

Im 25 years old, 5'1, and about 120lbs (used to be a gymnast), and right now I have an A cup. I have my first consultation for a breast augmentation on June 4. I'm getting mixed information about sizes. Some say you should go down a size from what you actually want and others say you should go one size bigger than what you want because when you wear bras, your breasts look smaller. Is this a myth or do I need to consider these options?

Doctor Answers 13

What size implants?

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How to Pick the Right Size and Shape of Breast Implants One of the more frequent questions I'm asked as an aesthetic plastic surgeon for patients considering breast implants is "how do I know what size, and shape I need?” The answer to this question has changed dramatically throughout the 25 years that I've been doing breast augmentation. I've also learned that the words that patients used to describe either what they want or don't want can be completely misleading into what I interpret their meaning to be. Therefore, I like to request that our patients considering breast augmentation bring in photos of both what they think they like and what they don't like. There seems to be a multitude of sources on the Internet where these photos can be downloaded. By looking at the patient's desires, I get a better understanding of what they want. We no longer recommend that we place the exact implant on top of the existing breasts and then place a stretchy bra over it to give us any idea what that exact same implant under the muscle would produce in size. That method, in my opinion, will always over represent what the actual result will be. If you are going to use a sizing type method, then Mentor makes a shell sizing system such that, when the shell size corresponding to the implant that it represents is placed over the existing breast and in a bra, it will better represent what that size implant under the breast and muscle will look like. We've also used 3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this method, a three-dimensional photograph of the actual patient is taken and can be seen on a large screen television by both the physician and perspective breast augmentation patient at the same time. We then can place all of the different implants that are available under that image and decide what size, shape, fill ratio, and height to base width relationships will look best for each patient. Silicone gel breast implants come basically into shapes either round or shaped. They also come with either a textured or smooth surface. In my mind, there are advantages and disadvantages of every scenario and combination of those choices. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. It's then very simple to just look at size and ratio projection to base width and select the perfect implant for that patients shape and desire. Sometimes we would like to use a textured surface implant. Here the advantages are that the textured surface implants tend to migrate less in the pocket, as there is some frictional resistance to motion. Another advantage of textured implants is that the capsular contracture rate, especially when implants put above the muscle, is less than for smooth wall implants. Shaped implants, because we do not want them to turn in the pocket, are always textured. My planning method to optimize the best implant for each patient is begun with a measurement of the base width of the breast. We would then like to subtract about a centimeter and a half total off of that number so as to have coverage of breast tissue over the implant. We then will have a range of implants whose base width matches that number. If we go larger than that number, which sometimes patients will want, we as plastic surgeons know that these larger implants can have more problems down the line. For instance, larger implants may migrate below the crease which one has to lower at the time of surgery in order to get the implant in. When these implants migrate below the natural crease, they can create a second crease in what we call a "double bubble". Large implants can also; because of the pressure they put on the overlying breast tissue, thin that tissue out such that there is less overlying breast tissue over the implant as time passes. After we have the base width, our next decision needs to be what is the ratio of the base width to the projection of the implant. Essentially, there are usually four choices ranging from fairly flat which is called low-profile, to progressively more height and less width with the same volume of silicone gel, which is called ultrahigh profile. There are two profiles in between which are the ones more commonly used and these are called moderate profile and moderate profile plus. Common scenarios in which taller implants would be desired may be in patients who want a larger look than their natural base with would allow or have a fair amount of loose overlying skin that were trying to hold up. For patients who want a more natural look, a moderate profile or moderate profile plus shape is more desirable. There are also anatomically shaped implants. Rather than being around these implants can either be taller than they are wide or wider than they are tall. There are good reasons in patients to use either. For instance, in the patient's with very widely spaced breasts and a large breastbone, a shaped implant that's wider than it is tall can help hide that a little bit. Another example of the patient in who a shaped implant would be best, is that patient with laxity after childbirth or weight loss. When the nipple is just at the level of the inframammary crease, we can sometimes get away with a tall implant that is anatomically shaped such that the nipple when is it at the lower two thirds of the breast mound created by the implant still looks good and natural and may obviate the need for a breast lift. By spending some time, long before the operation takes place, using the Vectra® 3-D imaging method, we can decide what type, shape, and ratio of width to height would best serve the patient's needs. We can then avoid what is sometimes done which is the placement of sizers at the time of surgery. These sizers, in my opinion, have a few negative implications. One is that there is a cost inherent in using them and usually multiple ones are needed to make a decision as to which implant would look best. I also believe that placing sizers in and out of the breast pocket can be traumatic to that pocket and can cause bleeding. For me, the state-of-the-art in today's breast augmentation is to decide long before the operation exactly which implant would look best using computer animation. A new wrinkle into the choice of breast implants is that breast implants now come with silicone gel that is filled to a higher volume in the shell where it is placed. This will allow for a round smooth implant, for instance to collapse less in the upright position mimicking more of the look of the shaped implant. When patients show me a photo of a very rounded upper part her breast, I would likely choose one of these higher volumes implants such as the Natrelle Inspira® silicone gel breast implant. Often times patients will present with breasts that are of different sizes. One of the options to correct this is to use breast implants of different sizes in order to best create symmetry. One of the newer methods to help in symmetry creation is to do what we call a hybrid breast augmentation. In the hybrid breast augmentation, the patient who has asymmetry of the breast to begin can have matching silicone gel implants placed and the overlying breast tissue can be made to look the same in volume and shape by using fat grafting. In that way, no matter what the change in weight of the patient is over time, the breast is more likely to have the same or similar size. When it comes to symmetry, I like to tell our patients that they should consider their breasts to be sisters that live across the railroad tracks from each other rather than twins. With proper preoperative planning and flawless execution of breast augmentation, this can be one of the most satisfying aesthetic plastic surgery outcomes for both patients and physicians.

Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

One size bigger or one size smaller than your desired size.

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The idea of going one size bigger is a myth as what is important is what you wish to look like after augmentation. It would be nice to think you can "try on" implants and read the number for the perfect result, but there is more art and judgement that goes into the perfect implant for you. As a surgeon we rely on our experience and good communication. Know what you wish to look like, and discuss this with your surgeon with care. 

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

One size bigger or one size smaller than your desired size?

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Having a "flexible" look with breast augmentation is important. No one wants to have overwhelmingly large breasts they can't minimize.  And large is a relative term.  Given your petite stature, even 30cc will make a difference.  I use a VECTRA machine in my practice to dialog with my patients about how they want to look.  It takes a 3D photograph of the patient and can simulate her appearance with breast implants of the selected size.  Ultimately, however, photos of how they want to look are helpful in either establishing the size limits or in my dissuading her from something I think will be too large for her.  My rule of thumb is to err on the smaller side if necessary:  a push-up bra can always oomph up any result when a patient wants to showcase her breasts.  It's impossible, however, to go smaller, once a larger implant is in place.  A board certified plastic surgeon is well-versed in accommodating these different factors and getting you a look you will love. Wishing you a fabulous result!

Whitney A. Burrell, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 14 reviews

Choosing breast implant size

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In my experience, choosing the correct size implant starts first and foremost with the patient having a good idea of how she wants to look.  From there, a board-certified plastic surgeon with experience should be able to take your vision and choose implants that will accomplish what you want to achieve.  I find that asking patients to bring in photos of how they want to look, and even photos of how they don't want to look, helps me choose approximate implant size.  Ultimately, you need to choose a board-certified plastic surgeon with lots of experience and expertise in breast procedures and communicate your desired size and appearance clearly.  Best wishes for a result you love!

Breast augmentation - choosing the right implant

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Thank you for asking about your breast augmentation.

  • Choosing your breast implants is a complex and important decision -
  • Yes,  breast implants look smaller inside your body than they do, outside.
  • Yes, women aged 25 and younger, tend to have very large implants and soon wish they had gone smaller.
  • Choosing an implant also depends on the look you want, measurements, your skin, your breast tissue and your surgeon's judgement.
  • Attached is my video on choosing your implants - to get you ready for your consultation.
Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

One size bigger or one size smaller than your desired size?

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Thank you for the question. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with. 

Implant size selection

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Every patient is different in what they want to achieve and the anatomy that they start with. Anatomy of the existing cleavage is a consideration along with the width of the available pocket that can be created. The higher profile implants may yield a less natural cleavage. Using sizers inside a fairly snug bra can simulate a pretty close look to the final result, with one caveat. That being that the implant will be wrapped with your own tissues and not the reverse as in the simulation. Many patients who like their result post-op will say they would have even gone bigger, but that doesn't mean they don't like their implants. A dimensional approach is hard to beat for consistency in results and natural appearance. Measure to see which is the optimal implant and then go with that or one size larger.

Jerome Lamb, MD
Independence Plastic Surgeon
4.9 out of 5 stars 7 reviews

One size bigger or one size smaller than your desired size?

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There is no rule for going up or down a size and most patients and surgeons can't tell the difference between one size and 25 to 30 cc more or less. Focus on the other variable and make sure you and your surgeon have a plan based on your body dimensions. Many women wish they had gone "one size up" so if you go up 25 to 30 cc from the initial size you pick, that's OK. See examples in link below. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

One size bigger or one size smaller than your desired size? = the size is the one that you would like to be #breastaugmentation

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One of the most common "problems" with breast augmentation surgery is patient dissatisfaction with implant size. This is often secondary to other than the patient choosing the implant size.

In my practice I ask the patient to choose the breast implant size by using breast sizers and looking themselves at a mirror. In that way, the patient chooses the implant that fits their desire, not the other way around 

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 140 reviews

Go with your desired size

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What does your surgeon recommend? Usually, board certified plastic surgeons will recommend a size that would suit your body and best achieve your expectations. The recommendation is based on a variety of factors, particularly your current breast dimensions, height, weight and other measurements. You should also consider your lifestyle. There’s no need to go one size bigger or smaller than your desired size. Just go with your desired size, since your surgeon will have selected one that is most suitable for you.

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.