Did I Pick Completely the Wrong Implant Size? They Feel Too Small.

Question

Hi, I am 5'11, 140 pounds, and just had breast augmentation 7 weeks ago. My original goal was a natural looking, well proportioned look that wouldn't interfere with my active lifestyle. My BWD is 13-14 cm. After discussing with my surgeon, we decided on 325 cc mod +. Ironically, I have been depressed with how small my implants look. Was i just way off in picking a size with my height? Am already considering revision to go up to 400-450 cc - do you think thats a more appropriate size for me?

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

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 a bit.  Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors. For more than 25 years, I have tried just about every method to best understand and achieve the patient’s optimal goal. The following is what I have found to be most accurate: To start with, I have found it most helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. This gives me detailed standardized views and information both qualitative (shape, perkiness) and qualitative (size) and allows me to discuss with my patients how I can best achieve their objectives as well as realistic expectations. For example, though I always tell my patients that I cannot make them exactly the same as a photo because everyone has different anatomical constraints. However, these ”ideal” breast photos are brought to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to best achieve their wishes. Even if the photo does not match their height or weight, I and most plastic surgeons are very good at translating the proportionality of the photo to your features.I personally order more than one set of implant sizes and use sterile implant “sizers” (temporary implants) placed in the created implant pocket during surgery to know in advance exactly which implant would work best for you in both a sitting and lying down position. This also allows me the opportunity to modify the pocket to meet some of the more subtle shape features desired. This enables me to use my full artistic potential to achieve your desired goals.

Ralph R. Garramone, MD · Answer

In my opinion if you are unhappy with the results of your breast augmentation due to the size implant selected, there is no way an online question and answer will be able to help you especially without being able to see you or a photo.

	I use implant sizers during the consultation so my patients can see in a mirror approximately how they will look after surgery and I have found that this method of determining implant size selection has virtually eliminated the size change procedure. I do also use measurements to arrive at a range of implant sizes which should be satisfactory for the individual patient.  Most of my patients who are quite active athletically prefer a more conservative size implant.

	Sorry to hear about your disappointment.  Communicate your feelings to your plastic surgeon.  Best of luck.

Tom J. Pousti, MD · Answer

I'm sorry to hear about your dissatisfaction with the results of breast augmentation surgery. Unfortunately, it would not be a good idea for you to rely on online consultants for advise about the breast implant size to use if you decide on breast revisionary surgery.

	Assuming you are working with a well experienced board-certified plastic surgeon, have a full discussion and communication regarding your desired goals.   This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.

	In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo;  etc means different things to different people and therefore prove unhelpful.  Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  

	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.

	I hope this helps.

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