Does Doctor Really Know Best? when Suggesting What Size Implants I Should Get or Should It Be my Decision?

Does Doctor Really Know Best? when Suggesting What Size Implants I Should Get or Should It Be my Decision?

Doctor Answers 29

Patient has the final say

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A big worrie that all women have is how to choose the right size breast implant for the look they want to achieve. It’s important to tell your plastic surgeon how you want to look, using different methods to help him visualize the result (photos,…).

Your plastic surgeon will guide you, after analyzing your breast and chest wall measures. He will use measuring devices to assure the choice is right for your size and weight and frame.

Then based on these measurements, your surgeon will take photographs, on which may explain the different options (shapes, sizes, ..).

In my opinion, the use of Biodynamic software (Natrelle-Allergan) that allows you (using different sizers in your bra) to see in a mirror the different options, clarifies most of the doubts.

As a final step, I think it is useful to use virtual simulation software. Both Vectra (Canfield) or eStetix (Crisalix), will help you to visualize how you will look with different breast implants. AxisTree is also a good choice.

In my experience, we have achieved maximum patient satisfaction with final results with this 6 step guide:

  • Patient desire
  • Clinical examination and measurements
  • Biodynamic
  • eStetix / Vectra / AxisTree
  • Surgeon advise
  • Patients choice

Spain Plastic Surgeon

WHO gets to Decide Which Breast Implants I should have Me or my Doctor?

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Not only is to road to hell paved with good intentions but so are all the side streets.

In my opinion the patient should always have the final say in anything involving her body, as long as she fully understand and accepts the short term and long term consequences of your decision. As long as you get several consultations, read and educate yourself on complications of breast implants (especially those having to do with large implants) there is no reason why you should not get the deciding vote in which implants go into your body.

However, all Plastic surgeons have encountered patients over the years who think that immersion in internet and chat room information is equivalent to that gained through years of surgical education and practice. If I encounter a patient who insists on having a procedure which I know is deterimental to her well-being, I have and exercise the ethical right to decline performing such a procedure.

With breast implants, placing very large implants into a petite narrow chested woman with little breast tissue coverage will ALWAYS result in rapid sagging of ball-like, ripple covered "breasts". These results can never be fully corrected and I refuse to produce such results.

Frankly, I would like my legacy to be that of an ethical, meticulous surgeon with beautiful results. As such, I occasionally have to decline operating on some people for their own well being.

Good Luck with yopur decision.

Peter Aldea

Always giving the patient what she wants without using my clinical judgment will occasionally

Peter A. Aldea, MD
Memphis Plastic Surgeon

Does the doctor know best in choosing breast implants? Getting it right!

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It isn't appropriate in my opinion for the doctor to just do what they want without regard for your desire and neither is it appropriate for the patient to tell the doctor what implant they think they want based on their own zero training and experience.  It also isn't appropriate for the doctor to turn you loose with a basket of implants and have you tell a nurse what you want to use so if the size isn't right they can tell you that it's your problem because you chose it.

Intraoperative sizers can be used sometimes but in most cases it is best for the patient to know what will be used going into surgery so there are no surprises.

What I personally do, and this results in almost no size change surgeries later, is to start out with patients specifically showing me from a page of sample "looks" what they want without clothing involved ie no push-up bras. I also don't factor in words like "fullness", "perky", and "natural" anymore because these mean such drastically different things to different people.  I have had so many who claim to want a "natural" result who pick out the fullest and least natural photos on the page!  If I had listened to their words, I would have gotten the size entirely wrong.

Next, I take therir own body into account, examine them, and measure them.  Finally we choose the profile of the implant that matches the "look" they want and find the right base dimension to fit them best.  This is then simulated in garments and adjusted to their taste. 

That works 99% of the time for me.

Implant size should be patient decision with surgeon recommendation

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Since it is your body you should always be the final decision maker.  Your plastic surgeon can help narrow down the range of implants that would give you the result that you are looking for.  You can and probably always should try on the implants in the office to make sure that the decision you both have made together was the right one.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Breast implant size

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Unfortunately your question does not include the specific breast implant sizes you are referring to. I am sure your surgeon wants to obtain an excellent result for you that you will be happy with, but that you are having a hard time agreeing on implant size. I suggest you do some research on the Internet regarding implant size, then bring photos of these and possibly some photos of a magazine like Playboy, and review them with your surgeon. I am sure this will enable you to agree with the best implant size for you.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Who decides implant size, doctor or patient?

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Thank you for the question.  Choosing an implant size and profile is a decision that the patient and doctor make together.

It is up to the patient to let the doctor know what she desires and to ask questions.

It is up to the doctor to listen to the patient, answer questions, and ask questions for further clarity.

Then, with the help of one of my nurses, the patient can try on different size implants to see which she likes the best. 

As the surgeon, I can help dial it in to the right base diameter and projection for any given implant volume.  

It is also up to the doctor to let the patient know if what she wants is reasonable and within safe medical limits. I only tell the patient "No" if what she desires is unsafe or not surgically possible. I also give input and feedback if I think a particular implant choice is going to be disproportionate and give my reasons why I think so.

Choose your surgeon carefully. Then, when you choose your implants, you can do it with the assistance of an experienced plastic surgeon who knows what he/she is talking about.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

How to choose a breast implant size

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Determining breast implant size should be a collaboration between the patient and the plastic surgeon. Sometimes, changing the type or the size of the implant can make a significant difference in the final outcome, even if the size is the same as what the patient desired.

Donna Rich, MD
Webster Plastic Surgeon
4.5 out of 5 stars 33 reviews

Patient Should Select Implant Size

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In my practice, patients make the final decision about the size of their breast implants.  I do try to educate them about the size with which they are likely to be pleased and does not present a high probability of problems (too large), but the patient is paying for the procedure and is the person who has to live with the results.  If a patient insists on an implant which is much too large and is likely to lead to capsular contracture, bottoming out, etc., I always have the perogative of refusing to perform the procedure and recommending that she see someone else.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Who decides the size of breast implants?

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It is the duty and obligation for the the plastic surgeon to educate and inform you about the safe range of implant sized that are measured for your specific breast tissue parameters and the risk of exceding these boundaries to your breasts in the short and longterm.  However, the final choice of what goes into the body is the patients.  The patient gives consent for the procedure.  A surgeon cannot place an implant in a patient that she is unwilling to have.  

If a surgeon is not comfortable with a specific size, he can refuse to do the procedure and refer the patient to someone who is.  Often, surgons may ask fo an additional consent to be signed by the patient acknowledging the added risks being accepted by the patient for  implants that are too large. 

Adam Hamawy, MD
Princeton Plastic Surgeon
4.8 out of 5 stars 57 reviews

Doctor or patient know best?

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The short answer is that the plastic surgeon knows best for the surgical issues and the patient knows best (for cosmetic procedures) when there is a choice that doesn't affect the surgery and the control over the outcome. 

Think of it like going to an orthopedic surgeon for a hip implant. You wouldn't tell the orthopedic surgeon what size of implant to use but he or she might give you a choice of the brand or the type of metal used. 

A plastic surgeon with experience knows what does best for short and long term results based on prior experience and the experience of others. This determines things like incision location, plane of the pocket (under the pectoralis muscle), and basic sizing/positioning of the implant. The type of implant (gel-filled or saline-filled) shouldn't make a difference in the look of the outcome and should be based on how the patient feels about the various advantages and disadvantages of the two types of implants in relation to their individual characteristics such as tissue coverage over the implant. The plastic surgeon should also choose the basic size of the implant based on the width of the patient's breast but the patient can choose among the three basic profiles scaled to the width (not always called this but basically low, medium, and high profile). For a breast of average width for the chest circumference, this corresponds to increasing the size of the patient's breast about a cup to 2 cup sizes. This is about as close as it can be called but the patient and surgeon know what implant is to be used before the surgery, that it will fit and look natural,  and what effect that should have. It should look like a natural breast about one to two cup sizes larger depending on the patient's choice of forward profile. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

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.