The breast implant sizers are a useful way of visualizing the approximate result obtained after breast augmentation. In the office the sizers are placed over your breast tissue. The actual implants are placed beneath your breast tissue and I prefer to place them under the muscles as well. The volume of the implants does not change after placement but muscle contraction over the implants could change the shape. Will you notice the difference between 280 cc and 300 cc? The difference of 20 cc is equal to 4 teaspoons or 2/3 of an ounce. When my patients have difficulty choosing between two sizes that are so close I generally recommend going with the larger size if their breast base width is sufficient. This might also require selecting a higher profile implant that is not as wide. I also have my patients size more than once if possible.
Most doctors choose to go slightly larger than the patient selection as long as skin availability is adequate. I think it is a mistake however to select an absolute size to be placed without allowing the surgeon the leeway to change slightly upward or downward based on the actual results seen during the surgical procedure. A 325 mL implant may look great in a bra but may be excessively round and tight under your breast and pectoral muscle. Or, to the contrary it may not give you as nice a cleavage or upper breast fullness as ideal. Consequently, I think the responsibility for the final implant choice should rest with the surgeon and not with the patient.
Breast implants placed under the pectoralis muscle will appear slightly smaller than the appearance of the in-office sizers that you can try on pre-operatively.
I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
Thank you for your question. I have been using the sizers for my patients to get ideas of the projected sizes of the breast augmentation surgery. Vast majority of my patients feel they get very good ideas of the anticipated results. The sizers also give you a tactile idea of the size. Most people feel they are very accurate.
You are right. When a sizer size is chosen and that size is then placed behind the muscle, it will appear smaller. I show my patients before and after photos of women similar to them in height, weight, frame and starting breast size who got different size implants in order to give them a better idea of what the final result could be. My patients tell me this is a very reassuring method. For more information on this and similar topics, I recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."
Thank you for your question. The implants typically look smaller once they're on the inside, under the muscle. We usually tell patients that they should size for the finished look they want and then go up one size.