How close are the in office sizers to your actual results?

Doctor Answers 12

How close are the in office sizers to your actual results?

I specifically avoid the use of in office sizing tools such as test implants or bag of peas.  I find them inaccurate as a tool.  My preference is to discuss the patient's goals realistically and review photos with the patient to set a target and then use my best judgment during the actual surgical procedure to match the patient's expectations.  I use test implants called "sizers" and while the patient is asleep we elevate the bed  into a partial upright position to see the actual appearance and shape of the breast with each sized implant.  I cannot imagine a more accurate and better way to achieve a goal based on my experience.  This avoids placing the responsibility for the implant selection on the patient and instead puts it on the surgeon's shoulders which I think is more appropriate.  Patients must realize that placement of an implant beneath the breast and pectoral muscle has a totally different effect than what is seen when an implant is simply placed in a bra on top of the skin.


Each doctor achieve success using methods with which we have grown comfortable.  It is up to you to find a plastic surgeon who gives you the greatest sense of confidence and allow him/her to do the best job for you.  Implicit in this is the need for patients to listen to the surgeon and be realistic in setting your goals based on the amount and volume of skin and breast tissue and the distensability present. Best wishes for good results.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

How close are the in office sizers to your actual results?

Thank you for the question.

There are several steps taken to select a specific size/profile breast implant for a specific patient.  Generally speaking, although useful as rough guidelines and as communication tools, all the modalities currently used to predict what breast implant size/profile will best achieve a patient's goals with breast augmentation are NOT very accurate, in my opinion. The use of the rice test, sizers placed beneath a patient's bra, goal pictures, computer imaging technology… are all useful, but not necessarily as accurate as one would hope.



In my opinion, nothing will replace careful verbal preoperative communication with your plastic surgeon, preferably in front of a full-length mirror along with the use of as many "communication" tools” listed above.



In my practice, I use all of the above modalities and then use intraoperative temporary sizers to help determine the best breast implant size/profile to achieve a patient's specific goals as closely as possible. For this reason, I think it is helpful to have the entire range of breast implant sizes/profiles available in the upper room.



Achieving realistic expectations prior to proceeding to the operating room is also an important part of the preoperative communication process. Patients should be aware that the results of their breast augmentation will not necessarily match exactly what they are visualizing with anyone of the above-mentioned communication tools.

 

Given your questions and concerns, I would suggest that you schedule additional time to spend with your plastic surgeon. This additional time spent will be helpful in the communication process and in alleviating some of your anxiety.



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 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.

The use of sizers

Thank you for your question.  Trying on sizers gives a rough estimate for implant selection and should be used in conjunction with other means of evaluation like taking measurements.  It's usually a slight under-estimate of the corresponding implant to be used.  Regardless, it's an important process for the patient, allowing the opportunity to look in the mirror and get an idea of the look and feel of different size implants.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck! 

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 reviews

How close are the in office sizers to your actual results?

Great question!  Doesn't it seem like it would be really straight forward and easy to figure out the best size implant for augmentation patients?  Using sizers is imperfect but I honestly think sizing with implants (done by myself) is the best way to get a pretty good idea of what size implant will work for any given patient.  I tell my patients that if put a implant in the sizing bra (a really tight sports bra) that they think is a little too large, that is likely the size we want.  The breast tissue and pec muscle tend to blunt the projection of implants so a little-too-large implant in the exam room often translates into just right in the operating room.  Also, I use intraoperative sizers which are inserted after I dissect the implant pocket.  This helps me see how the breast tissue, skin and pec muscle stretch with the anticipated implant.  Occasionally I will go up or down a size to get the best fit.  Implants are like clothing and shoes, they need to fit to look good!

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 67 reviews

How close are breast implant sizers to the actual results?

Thanks for your question.  If you have already tried on sizers, you have probably noticed that there is some air around them when they are sitting in the sizing bra.   The bra doesn't fit exactly the same way that it would if the implants were inside the breasts.   In my opinion the sizers do help my patients narrow down their implant choice but other techniques are also helpful (considering their breast dimensions/anatomy, 3D virtual imaging, before-and-after photos, etc.).

Sizers and results

This is an excellent question. Patients with very little breast tissue can get a very predictable idea of their new size. If you have alot of laxity of the skin the volume will be accurate but the shape may be less predictable. It is best to discuss this with your surgeon. I try to show patients photos of my patients before and after that look similar to the patient in my preop consultation. Seeing actual resuts I believe prepares a patient the best. There are some computer simulators that show results but I believe these results may not be realistic. 

Ralph M. Rosato, MD
Vero Beach Plastic Surgeon
5.0 out of 5 stars 7 reviews

How close are the in office sizers to your actual results?

Although sizers tried on in a bra on top of your tissues are not a perfect representation of what the breast will look like with the implants under your tissues, they are a helpful piece of information. When patients obsess over a 25cc difference between two sizers, I think this places a greater expectation of precision on the use of sizers than is justified. However, preoperative use of sizers can be helpful in identifying the patient who wants a conservative size increase along the order of 200-250cc's, versus the patient who wants a more moderate increase in the 275-375cc range, versus the patient who is looking for a more dramatic size increase of 400-500cc's and up. Of course, trying sizers on in a bra will only give information as to volume change and will not reflect how much upper pole breast fullness (ie: how natural vs. how obviously implanted a result) an implant will impart. So we have our patients bring in photos to help express what shape they desire, and then we try sterile sizers in the breast during surgery, sit the table up, and choose the implant as close to the patient's chosen size as will produce a result in keeping with the patient's desired shape.

Are in office sizers ( or 3D imaging) helpful for actual breast augmentation results?

Our office uses a traditional sizing system  and Crisalix, which is a 3D imaging system. Both are really helpful to see what you may look like after breast augmention. The traditional sizing system is only helpful if you have an experienced nurse assisting and guiding you. Crisalix has a 3D scanner that creates a topographical map and 3D image.  Once your image is created you can chose different styles of implants and sizes to see what you might look like at around 3 months after surgery. It is no guarantee of outcome but it sure is fun to see the results. We also have virtual reality goggles which place you in a virtual room with mirrors so you can instantaneously see your body with different implant sizes. You can even look down at yourself!

In office Sizing

Hello,

In office sizing is the most relevant way to determine and communicate information about your goal appearance to your surgeon. Period. A skilled and experienced surgeon can then interpret that information and make a selection of the most appropriate implant.  Among prospective patients familiar with the technique, there is a well known 'factor'  that needs to be accounted for when making the final decision. Most believe it is the addition of a certain amount to the volume of the sizer used if the actual implant is being placed under the muscle. In reality, there are more factors, and it is the job of an experienced surgeon to determine the final volume.  Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

How close are the in office sizers to your actual results?

The best that can be said is they are moderately helpful but in truth do not look like an internal implant. They are no more than a starting point. Sizers used during surgery, which are placed in your body in the space where the final implants are placed, are the only truly accurate predictor of what you will look like. Even the 3D computers are nothing more than a good approximation because they cannot take into account rib deformities, stiffness or laxity of breast tissue or of skin. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

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.