Is there a rule of thumb or tips for choosing breast augmentation sizes?

There definitely is a rule of thumb for choosing the right size implants.  Choose the size that makes you feel how you imagined you would feel if your breasts were always the size you wanted.  Sounds simple, simplistic?


Let's see what the process is for deciding what implant suits you. This is going to be a decision with long-lasting consequences and you want to avoid a re-operation just because you have found out after surgery that the size as not right for you. In the Mentor core study, at 3 years nearly 15% of re-operations were done for change of size or style).  We want to avoid this.


First recognize that every woman is different in how she sees herself, and what is too small for one woman may be too large for another.  When a woman first starts trying on gel implant sizers in the appropriately sized bra, she may be quite startled and even anxious about the difference.  This is common.  After a few minutes, the idea that this can actually be how you will look without artificial padding seems to overcome this initial reaction.


Your surgeon is trying to be sensitive to your feelings about what will work for you. Women commonly indicate that they want something natural, that they don't want anyone to know they have had surgery, that they want to be conservative because of concerns over how they will be perceived by  family, friends or at work. But again, this is not everyone.  Some women are not "conservative". They know what they want and if it is a larger look, they know that is what they will have.  After all, this operation is for your happiness and satisfaction only.


The sizing always begins by taking measurements of your breast base width and evaluating your soft tissue envelope. These measurements set the reasonable limits for implant width. This can be done by direct measurement as I and most plastic surgeons do, or with a computer-imaging device.  I have found that the 3-D tactile and visual information that women get from using the actual implants in the form of gel implants sizers is very important.  This virtually ensures that the choice will not be too large or too small.


During the sizing process, what you tell us, as you feel more at ease, helps refine the eventual decision. Your preferences can be reviewed repeatedly by you alone or with feedback from a friend, relative, spouse or significant other.  There is no rush.


For example, let us say your breast width is 12 cm. We know what size implants, both medium and high-profile will fit in that diameter (we rarely use low-profile implants).  A computer-imaging device would show the same information.


We know from what you have told us so far which direction you are leaning, more conservative, less conservative.  We encourage you to bring to the consultation several different items of clothing so you can see how you look in the clothes you usually wear.


Based on all this initial input, one implant size would be chosen to begin with.  Sometimes the patient says it is the perfect size.  But we know that sometimes when we give you the opportunity to try one "a little larger" that you may not see much difference and say that this one is "perfect" too. This process gives you the chance to try out how an implant looks and feels with no pressure whatsoever.  A little bigger, a little smaller, until you know very well what implant size is just "too big" and which is "too small".


Most women will narrow the size down to 1-2 sizes fairly quickly.  They then have the opportunity to go home, think about it and look at the cell phone pictures that they may have taken to review or show someone close to them.  If a woman has a moderate amount of breast tissue, we always tell her that there can be perhaps 10% loss of volume after a year, from the effect of the implant on overlying breast tissue. There seems to be a small degree of thinning of the overlying breast/skin envelope.  Since 10% of an implant in the 250-400 cc range is about the same as the difference between two sizes, this information sometimes makes a woman feel a little bit more comfortable in choosing the larger of their two choices, slightly bigger rather than slightly smaller.


Two groups of women who seem to have the most difficulty in choosing the "right" size are the women who are very afraid of being too large and those who want to be quite large. The former tend to want implants in the 180 to 250 cc range.  These are the smaller implants and are often chosen by slim or athletic women who definitely want to look natural and not be seen as having had breast augmentation. They are usually happy with the results, but in my experience are more likely after the surgery and living for some time with the implants, to feel that they should have gone bigger, or request re-augmentation with larger implants.


Women who are comfortable with the larger sizes, 400-500, are usually very comfortable with their choices. However I have noted that women in this group are also more likely after surgery to wish they had had a larger implant.  It is important to realize that trying to place an implant that is wider than the internal breast base diameter is more likely to lead to stretching of the skin, numbness and eventual re-operation.  Therefore, it is not recommended. Sometimes women who request a "D" cup find that they could have gone even larger.  Since we never want to make someone larger than they wanted (a great source of unhappiness), we have to spend more time and more than one sizing session before coming up with the final decision.


If an implant that fits the base diameter is smaller than preferred, then the patient can see if she likes the look of the high-profile implant.  A high-profile implants allows more volume in the same diameter than a moderate-profile implant.  For example, instead of a 350 cc implant, the same width might accommodate an implant that is 450 or more.  The difference is that the high-profile implant will not come out so far at the sides and will project forward more.   Then, it is important to decide if the patient even likes the look of the high-profile implants. This is an individual taste, which is easily determined by trying on the different implant styles.  We offer every patient the chance to see what she thinks of the moderate and high-profile implants.  Some women immediately know that they do not like the look of high-profile implants, while some women find they prefer them.


In summary, whether the sizing is done by computer or by use of sizing implants, if a woman has the chance to both see and feel the implants, and feel that she is in control of the process, the outcome will be good. If there is uncertainty, particularly a lot of uncertainty, then it is time to step back and use the information gained in this sizing process to re-evaluate what one really wants.  Sometimes, after sizing the patient becomes very energized and enthusiastic, and sometimes she needs to stop and think for some time. In the end, by giving yourself time to adjust to the potential new image, you are likely to be happy and not to have regrets about your size choice.  The doctor and staff can help, but should be non-judgmental and supportive, and not try to influence you or try to make your decision for you.


 

Deciding on which implant to useis always a difficult decision for women. The benefit is that in this day andage is that there are so many choices of implants that the augmentation can betailored to each patient.

Truly the best thing that you can do is be openwith your surgeon about your desired results so they can help guide you inchoosing the best implant for you. I would spend time trying on various implants inyour surgeons office and don’t be afraid to do this more than once. In my officeI use a Mentor Sizing System that allows the patient to try on a variety ofimplants with a bra and tank top so that they get a realistic feel and look atwhat their result will be after their breast augmentation.



Once you have decided on thevolume (size) implant that you like, I will use your body measurements to helpguide you to what implant will fit your body best and help you achieve youraesthetic goals for your breasts.



Also bring your surgeon picturesof what you want to look like after your procedure. This will make sure thatyou and your surgeon are on the same page about your implant desires. It is important to see your board certifiedplastic surgeon to help guide you to an implant that will give you anaesthetically pleasing breast.

The best way to determine the size that is right for you is try on sizers.  Volume sizers are placed in a bra, and you get to look at the approximate results with breast augmentation using that size implant.  Measurements are also made of the breast to determine which implants will fit best on your chest wall.  A board certified plastic surgeon with vast experience in breast augmentation should listen to your subtle clues about size, and see how you respond while trying on sizers.  With the advise and guidance of your surgeon, only you can determine which is the best size for your perception of your body!

This is a very common question and there's no easy answer. There are literally hundreds of implants to choose from but fortunately your surgeon should be able to help guide you to select the implant that will give you what you're looking for. 
There are several main considerations - 
1. Implant width - this is one of the most important factors. Essentially the width should fit your chest width. If it's too narrow or wide it can have negative impact on the outcome. If you want more "sideboob" you can go a little wider but you need to do this conservatively. 
2. Implant projection - The projection profile ranges from low, moderate, full and extra full. Various companies have different terms for this but essentially it's how much projection you can expect. So if you want to avoid the "top heavy" look then you wouldn't want a extra full or full implant. Most patients seeking a natural appearance go with a moderate or full. 
3. Volume in CC (cubic centimeters) - this is what people focus on but it is directly related to the above factors. 120-180cc roughly correlates to a cup size. 
4. Cohesiveness - the majority of breast augmentations are using silicone implants. The are now multiple different options for cohesiveness levels. Natrelle has the responsive, soft touch and cohesive options. The more cohesive the more upper pole fullness you will achieve. Most patients go with the responsive. 
I use a sizing system to help get an idea of what volume you might be looking for and then depending on your chest wall width we can narrow it down to a few different options for the projection profile.
 

What size implant is right for me? This is the ultimate question in breast implant surgery.
The good news is that this is a question that involves the plastic surgeon and the patient. You have just as much input in this decision as your physician.
I think most physicians appreciate it when patients bring photos of celebrities or people on social media that they like. Before and after photos from the internet are also very valuable. These images can help your physician understand what you are expecting from the surgery.
After looking at the photos and discussing a patient's expectations, the physician has several options to show the patient how different size implants will look. The first method is placing the actual implants in a shear bra and shear T-shirt. By looking at a full length mirror, the patient can have a general idea what certain sizes will look like and how proportional they are for the rest of her body. Studies have shown good correlation with results and patient satisfaction with this type of sizing.
If a physician has access to more current technology, such as the Vectra 3D, the physician can show how different implants might look. How does 3D simulation work? A computerized image is taken of the patient and the computer technology can perform a virtual operation, so the patient can see how different sizes look on her body. This is a virtual simulation and is not a implied gaurantee of results. It, however, is another way for the patient to be able to determine a range of implant sizes she might be comfortable with.
Once a certain size is determined, it is important for the plastic surgeon to examine the patient and perform measurements to make sure a certain style of implant will fit or is appropriate. This is a very important part of the consultation.
One thing to consider is that bigger is not necessarily better. Larger implants weigh more and stretch the skin and muscle. Think of them as weights. The heavier the weight, the greater likelihood they may sag over time. The ultimate goal is to get a size that you are comfortable with, but does not put you at risk for "sagging", which might require a breast lift in the future.
So you see, breast implant sizing is a joint effort between the patient and the plastic surgeon. The better communication both of you have, the more likely you will be happy with the results.
Good luck with your surgery!

The breast implant size question is one that every patient has at some point during the consultation process. The way I approach this is to first listen to my patient. I want to know what she wants regarding her look, desired cup size and other aesthetic goals. Some women want a conservative implant, so no one knows that she has had a procedure. Other women want to be proportional and balanced. Still other women want people to wonder about it, maybe they are natural or maybe not. Other women actually want to look augmented, or be as large as she can possibly be.Once I know that, I can make recommendations regarding implant size based on the patient's breast measurements. There are also different styles of implants that will give a different post-op appearance. Best of luck!

There a  few factors when choosing implant size.  Most importantly, the implant must work with your breast dimensions.  After that it is based on each patients desired look.  I use 3D imaging and have patients bring in pictures to understand what visual result is desired.  I do not use cup size, it is very subjective and arbitrary.

You would think there would be a set of measurements or a computer program that would tell you what implant size to get, but there is nothing that really works. I find it useful for a patient to show me photos on her cellphone, and we also look at a bunch of before and after photos that I have in my office. Her reaction helps me to know what size is likely to make her happiest. Incidentally, my average implant volume is about 400 cc. Some surgeons have a preference for small sizes and will tell women that they should not go too big or they will regret it or have more complications. This is not my experience - in fact my patients who choose large implants tend to be the happiest. Remember, it is your body and your decision. You don't want to err the other way either, and wish you had gone bigger because it is obviously expensive to have to repeat the surgery. You can read more on this topic on my website. I have attached a link.

There are multiple factors for consideration when it comes to choosing the right size for breast implants. To make it simple and less confusing, my guiding principle for my patients is all about striking the balance between what the patient wants, what the patient's got and what the surgeon recommends.

What the patient wants: obviously it relates to patient's desires, concerns, and fears with respect to their style preference (eg. for a natural looking result vs an enhanced accentuated effect) for the ideal surgical outcome to individual expectations. Medical backgrounds including pregnancy & breast feeding history, any significant weight fluctuation will also influence the choice of specific implant size & shape in achieving the preferred surgical result. Social factors such as exercise routine & lifestyle preferences can also have bearings in the choice for the right sized breast implants.

What the patient's got: individual patient's breast dimensions, body frame proportion, patient's weight & height as well as breast tissue quality are important baseline parameters in deciding the appropriate breast implant size & shape to match the desired patient preferences. Various tools such as implant sizers or 3D imaging may also assist in the decision making process, but ultimately it boils down to the trust and confidence you have with the surgeon in selecting the appropriate implants for you.

What the surgeon recommends: different surgeons have different styles and preferences based on their perception of what the patient wants and their clinical assessment of the patient's situation. There is no short cut to good communication and I believe your surgeon should be able to give you the confidence & belief in choosing the right sized implants by outlining all the reasons involved in the recommendations. Remember it's not about predicting the right bra size that you'll be having after surgery, but it's really about having the "perfect" breasts that you desire to achieve together with your surgeon's help. Effective communication is always the key to achieving the ideal surgical outcome for both patients and surgeons.

Best wishes

Ellis Choy

Thank you for your question.Picking the right implant size can seem overwhelming when going through photos online. A 350cc implant on one woman can look completely different on another. During a consultation in my practice, we use silicone sizers as well as 3D imaging to help guide you to the proper implant size.As a rule of thumb, typically 150-175cc will give you one cup size increase in volume. This can vary based on height and weight. That is why it is best to consult with a board certified plastic surgeon who specializes in breast augmentation surgery. It helps to pick out a before/after pic of a patient with a similar body type. The consultation is a lot of fun and breast augmentation surgery has shown to be a very satisfying procedure. Best of luck to you and I hope you are able to pick a proper size implant.Sincerely - Dr. Bryson Richards (Board Certified Las Vegas Plastic Surgeon)

Thanks for your question!  With regards to choosing size for implants, this is partially
a personal decision and partially a decision that should made based on the
patient’s anatomy. The key measurements in breast augmentation is the base
width of the breast, which corresponds to how wide the patient’s natural breast
is. The breast implants should be very similar in width to the base width of
the patient’s natural breasts so they look like they are a part of the
patient’s body. Therefore, patients with a wider chest generally need a larger
implant and patients with a narrow chest need a smaller implant. There are many
different profiles for implants as well which means that some implants of the
same volume will have a narrower base width with more projection whereas some
will have a wider base width with less projection. These different decisions
can be made between the patient and the surgeon in order to achieve the overall
look and shape they want while at the same time ensuring the implants fit the
body. I do feel if breast implants are too large they can cause significant
problems and this is one of the reasons I see many patients in for revision
surgery. When I see these patients and correct them, I generally feel that if
the implant that was initially chosen had been more appropriately fitted to
their chest it is likely their postoperative issues would have been less
serious or possibly not have occurred at all. Proportion is very important and
in addition to measuring the base width and choosing a relatively close match
with implant width I also feel that preoperative sizing can be helpful for
patients to see what they will look like after surgery and to help them and the
surgeon make a good decision for their procedure.