Confused About BWD Meaning. I Am 12.5 Cm Should my Implant Diameter Be Less Than That?

Question

A surgeon I consulted suggested that my ideal implant size is about 300 cc (HP) maximum to avoid looking too fake. I am an A cup and would like to go up two sizes. Looking at the Mentor HP info, it listed the diameter for a 300 cc HP silicone implant as 11.1 while the 375/400 implants were closer to my BWD (12-12.2 cm). Would 300cc HPs widen the gap between my breasts? Should one only get the implants smaller than her BWD? Me: 5'10/135lbs/28" ribs

Gary Lawton, MD, FACS · Answer

The best way
to determine the size that fits your personal perception of the perfect breast
is to try on sizers. This way you can see how they fit on you, how they add to
your current volume, and whether they fit your frame. Although the surgeon can
guide you, only you will be able to tell what is the right size. Try on sizers.
 HP implants, which are a more modern shape than moderate profile
implants, fit most women better. They have a more appropriate base diameter for
the average women's chest.  Mentor HP profile saline implants have base
diameters that range from 8.8 cm (very narrow) to 13.8 cm (moderately wide).
 The majority of women in my practice have base diameters in the 11 to 13
cm range.  The HP implants fit them well.  The moderate implants have
much wider base diameters for the same volume (often in the 14 to 15.6 cm
range).  These implants are too wide for most women that I treat.  So
when the base diameter is measured and correlated with the diameter of the
implant, it is most often necessary to use HP implants to achieve the volume
the patient is requesting.  At the volume selected, my patient's base
diameters are too small for moderate profile implants. Measuring a diameter and
then telling the patient what volume they can have (in high, moderate or
moderate plus implants) in my mind is backwards.  The patients should be
allowed to choose the volume.  Then the surgeon carefully considers the
base diameter, projection, profile, manufacturer, and fill material that will
achieve the patients goals of size as well as qualitative look (natural,
intermediate, or bold upper pole fullness or projection), all the while taking
into consideration the patient's anatomic features that will affect the
outcome. HP implants can be made to look very natural or very augmented,
depending on where in the range the implants are filled to achieve a particular
volume. At the low end of the fill range, HP implants do not have the upper
pole fullness that most people associate with the fake look. On the other hand,
a fake over-augmented look can be created with a moderate profile implant if it
is overfilled (a common practice for surgeons that commonly use moderate
profile implants). In addition, too wide an implant will put the volume past
the anterior axillary fold, which in my opinion, looks more fake than upper
pole fullness.  So there are many factors that need to be considered.
 The experience of the surgeon and the degree to which they explain the
options to you is of utmost importance.  Obviously all of my patients look
at photographs and we evaluate the look they are desiring in great detail.
 For me, high profile implants are the first choice. I rarely find an
indication to use moderate or moderate plus implants. Look at the outcomes and
judge for yourself.   The outcomes should stand on their own. The subtlety
in the final outcome is not achieved by which profile implant is used, it is
determined by the skill in the creation of the pocket, the choice of volume,
and where in the range the implant is filled. Don't let the doctor tell
you what would look good on you.  They cannot tell what you perceive to be
the best size.

Luke J. Curtsinger, MD · Answer

You are correct, that if you put in implants with too narrow a base width, then you can end up with a 'space' between your breast mounds.   Not good. Base width can be adjusted to a desired base width, slightly, but for a natural result, you need an implant that is similar to your natural base width. Once  the base width is chosen, then different profile implants can be chosen to achieve the desired size.  300 cc implants won't increase you two cup sizes, possibly closer to one cup size. With shaped implants, we have the ability to control the width, height, projection and volume, and better customize the implant choice for a better fitting and more natural result.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question!
  
After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.
  
Silicone will give you fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.
  
Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
  
During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.
  
We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.
  
The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
  
Best of luck!
  
Dr. Schwartz
  
Board Certified Plastic Surgeon 
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Larry S. Nichter, MD, MS, FACS · Answer

Best decision is to pick the best surgeon and not try to do his job and pick your own implant.It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below:#HowToPickAnImplant

Armando Soto, MD, FACS · Answer

Hi there-

	These types of questions are the most commonly asked... and are unfortunate in that the implication is that choosing the implant you want is like deciding what you want to eat at the Boston Market counter...

	Choosing an implant is really a very nuanced undertaking, and is not as simple as taking a few measurements and looking at a chart.

	The very best advice I could give you (and which I give at least 10 times a month) is to spend your time and energy finding a quality, experienced, skilled, and Board Certified Plastic Surgeon first, then carefully communicating your goals for appearance. Then, let your chosen surgeon advise you on the details of the procedure most likely to achieve those goals for you.

	This will eventually require you to make a leap of faith, but will greatly lower the risk of you needing a revision surgery when you figure out what we already know- that it is not possible to predict accurately what an implant will look like solely by external measurements and playing with implants in bras...

William Bruno, MD · Answer

Breast width is one of the factors used in determining breast implant size.  Typically you want your breast implant to be no wider than then width of your breast. There are other factors such as breast volume, skin quality and breast shape which factor into this decision. A board certified plastic surgeon can help you choose the implant that is best suited for your anatomy which will also get you to the cup size you desire. Generally speaking, a high profile implant is narrower and better suited for a person with a narrow chest/breast.

	Best wishes,

	Dr. Bruno

Shahram Salemy, MD, FACS · Answer

When helping a patient choose the right size implant to reach their goals, we take into account several factors, and one of them is the breast width. In general, I recommend an implant that is slightly smaller than the width of the breast-- this will allow it to sit comfortably and have a more natural look. High profile implants give the most projection (distance off of the chest wall, or height of the implant) for a given diameter, but the profile that we choose really depends on a combination of your anatomy, your goals, and the surgeon's experience with the specific implant.

Otto Joseph Placik, MD · Answer

You have forgotten to take into account the thickness of your breast skin and tissue which is generally 1-1.5cm. Therefore an implant with a diameter of 10 cm, when placed in the breast, will actually make the breast measure 10cm + 1-1.5cm (skin towards outer part of breast) + 1-1.5cm (skin towards inner or cleavage side of breast) = a total of 12-13cm BWD. If you work backwards you can see that a 10cm implant will make minimal difference in your breast whereas placing an implant of 12 cm will probably produce a breast that is 14 -15 cm and likely increase the cleavage (make the breasts appear closer together)/

Sugene Kim, MD, FACS · Answer

BWD means breast base width.  In recommending implant size, I consider my patients' anatomy (chest height, weight, shape, existing breast tissue) as well as their desired look.  Please share your "wish" photos with your plastic surgeon. After examining your body and understanding your goal, your plastic surgeon will make a recommendation.  Implants come in different type (saline, silicone), shape (anatomic, round), volume, and profile.  Please visit with a board certified plastic surgeon.  Best wishes,Dr. Kim

Sheila Bond, MD · Answer

Yes it is confusing. I use the breast width measurement as a guide along with other information such as the size you wish to be ,amount of breast tissue present, skin quality, shape of your breast, and your waist and hip proportions just to name a few. I also have the patient try on sizers to get an idea of what she will look like. I spend a lot of time on this prior to the surgery to be sure you get what you expect.

Confused About BWD Meaning. I Am 12.5 Cm Should my Implant Diameter Be Less Than That?

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