How to Pick
the Right Size and Shape of Breast Implants
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.
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.
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!
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!
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
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.
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.
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.
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
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.