Disagreement with Surgeon on Implant Replacement Size. I Want the Smallest Implant, but One That Will Work with my Diameter?

One month from surgery. Had my saline implants deflated today by a needle in the surgeons office. I am definitely saggy & have upper emptyness, but also realized how much I missed my smaller size. I am a 32A normally. I want to replace w/ silicone that will fill out the emptyness, but keep me petite. Surgeon wants to go larger & only 30 ccs smaller than my old ones & not with a low profile. I'm afraid its going to be too big & I want to be happy in the end. Advise? Can he refuse to go smaller.

Doctor Answers 6

Communicating with Plastic Surgeon?

Thank you for the question.

Based on your question, I think it is obvious that you need to spend additional time with your plastic surgeon prior to surgery day. This time spent will be critical in communicating your goals/concerns as well as learning about your plastic surgeon's  thoughts and concerns.

 In my practice, patients' goals are often best communicated with the use of goal pictures,  as opposed to discussing cup size and/or using words such as “petite”.

As you know, one of the considerations that must be discussed while planning this type of surgery, is the presence of “saggy” skin that needs to be “filled out” by the appropriate size breast implant;  the use of an implant that is too small may leave you with residual skin looseness.

 I hope this helps.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Implant size change

Your surgeon can certainly refuse to operate on you if he or she feels it is not in your best interest.  By the same token, you are free to shop around and find another surgeon with whom you see more eye to eye.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Implant choices

As a surgeon I listen to my patients very carefully and come up with a plan with them so that they are happy. If the implants you feel are too big then speak up.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

It is important to have you questions answered by your surgeon

It is always important to have all of your questions answered prior to any surgical procedure.  The time for questions isn't during the recovery phase.  If you have questions about what your surgeon is recommending you need to revisit the issue with them and have your questions answered to your satisfaction.  If the surgeon is not able to do that then you should get a second opinion.  The other thing is to be realistic about the results that can be achieved.  In your case, wanting to be small and petite yet wanting the upper part of the breast full is potentially contradictory.  Your surgeon may be making a recommendation based on what is needed to fill the upper pole, but if your main objective is to be smaller you may have to make some sacrifices.  Go back and have an open, honest discussion with your surgeon so that you feel comfortable with your final decision but understand there are trade-offs to every decision.

Jason E. Leedy, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 126 reviews

In breast augmentation you can't have your cake and not eat it.

No Board Certified Plastic Surgeon should presume to tell a patient what size her breasts ought to be UNLESS the size of the implant is important to correct some of the features of which the patient complains. For example, a larger size is often required to correct lack of fullness in the upper pole. An alternative is a breast lift, but this involves more scars. You choose!

Unrealistic expectations are the bain of a Plastic Surgeon's life. "I want a full upper pole with no scars and I still want to feel small." or "I have stretch marks and loose skin on my tummy but I don't want a tummy tuck."

Much of this may be avoided by better communication between doctor and patient.

J. Brian Boyd, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 5 reviews


ask your surgeon to explain to you why they are recommending this implant. it could be that a smaller implant would result in you needing a lift and therefore more scarring

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 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.