How do doctors decide what size implant to use during breast augmentation surgery?

As you see from answers submitted, there is no one way to determine size, so each surgeon will tell you how he or she selects.My approach is to apply four criteria, all equally important.  First, I listen to what the woman wants.  Women choosing breast augmentation generally have more or less specific ideas about the breasts and body they desire.  Listening involves learning about the woman's lifestyle, her activity level, and considering her stage of life. Breasts must also be considered within the context of other facial and body features.  In my opinion, larger breasts can be used to visually narrow a woman's waist, and complement other attributes, such as a beautiful face.  My goal is to get as much "mileage" out of the implants as possible.  Her individual aesthetic ideal must be considered:  Some women want large implants that look like implants, round and high.  Others want a subtle enhancement, unrecognizable as augmentation, naturally adding gentle feminine curvature without specifically drawing attention.  The second criteria is base width of existing breast.  The implant must be about as wide as her breast so there's not a central gap between the breasts, and so they don't hang out to the sides too much (unless she wants "side boob").  Angulation of ribs must be considered in the calculation of implant width as well.Next (third factor) is how much breast she's starting out with.  If she is very flat chested, a higher profile implant will be needed to achieve her goals.  If she's starting with a full B or small C, then a smaller implant will be needed to reach her desired size.  Fourth is the skin envelope.  If she has had children, especially multiple children, nursed, and has a loose skin envelope, a larger implant can be accommodated.  If her skin envelope is tight, it is more difficult to use an ultra-high (full) profile prosthesis without stretching the skin and connective tissue, a process that may be irreversible.  Breast augmentation should be explained within the framework of her multi-faceted life.  It is helpful, I believe, for women to understand changes they can expect over time.At no point did I mention implant volume, because it is meaningless.  A 400cc implant can be wide and flat or it can be narrow and globular.  Volume is immaterial relative to dimensions.  Beyond size, the texture of the implant, surface, positioning, and approach for placement affect the final outcome considerably.

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 below link.#breastaugmentation#findingtherightsize#BA

At
size 32 or 34 each 100 cc’s of implant corresponds to 1 cup size change.At size 36 or 38 each 200 cc’s of implant
corresponds to 1 cup size change.From
this, you can compute the volume required to achieve your desired goal.I always recommend small round textured
silicone gel implants placed retro-pectoral since they look and feel more
natural, are more stable, less likely to ripple or have complications needing
revision.Implant profile is irrelevant
in the retro-pectoral position since the muscle compresses it.Best Wishes,Gary Horndeski, M.D.

This is always a difficult decision for some. In my opinion, the best thing to do is have a thorough sizing session. I provide my patients with a range of about 3-4 implants that are appropriate for their specific measurements. I then have them try these implants on in a special sizing bra. With this process, my patients have been able to choose their own implants. I have found this to be the best method for implant sizing. Be sure to see a board certified PS in your area. They should be willing to spend the time with you doing this. Best of luck!

Every plastic surgeon needs to make that decision for themselves and their patients based in their judgement and experience.  I recommend size based on my experience using implant sizes in the past considering each patients desires and goals as well as their individual build.  I almost always commit to a size the morning of surgery and don't stray from the plan I tell the patient.  That way there are no surprises or disagreement afterwards about me "changing plans" in the middle of surgery without the patient's knowledge.  But each surgeon makes that decision on their own.  You will probably get different answers from each doctor.

Sizing should be based on tissue characteristics, just like when you buy a shoe the shoe has to fit your foot, if your surgeon does enough measurements they should be able to give you a range of sizes that will fit your body

The choice about which size and type of implant to use should be a collaborative decision between a doctor and his/her patient.  The patient has a goal in mind and the doctor has, in his/her mind, an idea about what might work best towards helping the patient achieve her goal.  This is why it is so important for doctors and patients to communicate well with each other.Different doctors have different methods for deciding on which implants might work best for their patient  If you talk to five different doctors, you might get five different opinions.  It is not that one doctor is right and another one is wrong.  Instead, we each go with what works best for us based on our experience and training.  Also, it is not like putting bumpers on Chevrolets.  There is no formula for converting cc's to cup sizes.  Each patient is different and must be assessed individually.Finally, even bra manufacturers do not have standard cup sizes.  We can put you in the ballpark of what cup size you might want, but we can't guarantee a cup size.  That may depend on where you buy your bras.

It is very difficult to determine bra size strictly by implant cc's.  Every body is different and where a 300 cc on one person may change the cup size by one size, in another patient is may change cup size by 2 or 3 sizes.  In my practice we spend a great deal of time on the sizing aspects, after all that is what it is all about.  During the initial consultation we determine the look and size that the patient is trying to achieve.  I also perform and exam and perform measurement and determine the skin envelope quality.  I then ask the patient to perform the rice test at home.  Even though it is a crude test, the benefit of it is that you can perform it in the privacy of your own home, and take as much time as you desire.  I also ask the patients to bring in photos if they like, but to bring in photos of patients that are similar to their height and weight and breast proportions.I meet with the patient again during the preop visit.  It is at this visit that we spend all the time on the sizing.  We use the Mentor Volume Sizing System which works very well in determining the look that the patient is striving to achieve.  After this visit, my patients are very confident and satisfied with their sizing and all the guess work as been put to rest.Hope that helps.

In our practice, we like to select the anticipated breast implant size before surgery.  There are many factors that allow a breast implant of a certain size to be placed, so a skilled surgeon can guide the patient to the correct range given their measurements, breast configuration, skin quality, etc.In some cases, we'll specify a small range of implants, the doctor to decide during surgery which to place.  For example if the patient had a tight lower pole, we would calculate the anticipated safe size for the patient.  But if a larger sizer were placed during surgery and it appeared perfect, then the patient would have given permission in advance for a larger size to be used.Carte blanche permission for any size the doctor feels fits best is generally a poor idea, since aesthetic standards vary greatly.It's also a bad idea to specify or guarantee a certain cup size, since opinions differ on what actual cup sizes are (as any woman being measured for a bra can attest).

The choice of breast implant size depends partly on the surgeon's judgment, partly on the patient's wishes, and partly on the patient's specific anatomy. For every woman, there is a range of implant sizes that would be appropriate to use based on her own body dimensions and tissue characteristics. In other words, not all implants will "fit" the patient's chest wall, breast dimensions, and tissues in a satisfactory manner. Using an implant with a diameter that is too great, for example, can cause problems in the future. Your surgeon should be able to guide you as to the range of implants that could reasonably be used. Within that range may be several implant sizes that would do well in your body. I think it is critical for the surgeon to spend time with each patient in order to understand her goals and wishes fully. In my practice (my office is in Orange across from St. Joseph Hospital, by the way, very close to you), patients show me photos of their approximate desired fullness and shape. I take measurements of their breast width and other factors, and they try on specially designed sizer implants made by Mentor, one of the main implant companies. From all of this, my years of experience as a plastic surgeon allow me to determine the 2 or 3 sizes that would most closely achieve the desired look. I then take all of these sizes to the operating room with me. During the surgery, I insert a "sizer" implant of the same type as the implant that will be used, then sit the patient up to see how well the selected implant accomplishes our goals in THAT PATIENT'S BODY. Most of the time, we use the implant I thought we'd use before the surgery, but sometimes I choose a slightly larger or smaller implant to obtain the best results. Some surgeon's prefer not to spend the extra few minutes to do this, and instead make the patient commit to a specific implant before surgery, but I think it's absolutely worthwhile. The number one cause for revision surgeries in the first 3 years after augmentation is size change. In 16 years, I've had only a few patients who requested a size change after surgery.I don't like to discuss augmentation in terms of cup sizes, since cup sizes are very random and inconsistent. A woman may use a C cup in one bra, and a D cup in another bra. I ask my patients to focus on the LOOK they want to achieve, not the specific cup size, and I'll do my best to achieve that look. As I noted above, I've been incredibly successful with this approach.My office is in Orange, across from St. Joseph Hospital, very close to you. Please visit my website below and contact my office if you'd like to meet with me for a free consultation. I'll explain all of this to you in detail, and you'll leave feeling very confident in your decisions.Good luck!