Does the plastic surgeon ultimately let you choose what size of cc even if its not what they recommended?

Hi K,I believe you have received good advice.  I agree, it is in general 200 cc for each cup size.  Be aware VS "over-sizes" bras.

Here are a few tips for you because this is perhapsthe hardest decision for a patient to make, as well as the surgeon.  Also see the video attached to my answer.  We spend up to two hours for our BA consultsto be sure there is careful communication. We do a full exam in front of afull-length mirror taking six exact measurements.    Weput your photos on a large computer screen for imaging, and go over your“ideal-size” photos. We then save this information to your password protected“web account.”

     First and foremost the implant should fit the dimensions of your breast and tissue cover. Balancing the implant to your over-all body shape and tissue cover is essential.    The main thing is to have the diameter of the implant fit the diameter of your breast "foot-print". Higher profile implants tend to have a smaller diameter.  Higher is really a marketing term, but often translates into the same volume implant with a narrower base.  Saline implants actually tend to decrease in diameter as they are inflated!  The average size chosen over our last 7,000 breast implants was “350cc”.  BUT, 90% of our patients tell us they wish they were bigger a year after BA.  (We will see you every year for routine checks at no charge.) It’s like your mind incorporates the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patientsthat they will experience an increase of approximately one cup size per 200 cc. You can try on implants in the office by placing them into a special bra.  The implant is also flattened somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account forflattening of the implant in the partial sub-muscular pocket.  Once you decide on a size you like, then add on 25cc, because in real life the implant will be flattened slightly by yourtissues.  Multiple measurements need to be taken to fit an implant to your exact anatomy.  Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer.  Then you and your surgeoncan piece together the puzzle by matching your measurements, with your wishes,versus your tissue cover and the available implants to arrive ata surgical plan.  Keep in mindlarger implants tend to have more problems over the years.  Since silicone implants wrinkle less thansaline implants, they might be your best bet.

     You canalso approximate this at home by measuring out an equivalent amount of riceplaced into a cutoff foot of old panty-hose, and put this in your bra.  Wear this around the house for a while, andsee what you think.  Implant size mustsquare with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wallare taken (seven in total).  Implant sizeselection has been an issue of much discussion.

    Therefore, I use a wide variety of methods, but the implant size isalways established preoperatively.  Also,patients are advised to bring reference photos demonstrating their ideal sizeand shape.  A photo album of patientpictures is maintained to assist them.  These photos ultimately help in determiningwhere the implants will be placed, since they can be shifted inside (to providemore cleavage), to the outside, up or superiorly, and down or inferiorly duringsurgery.  In determining the final sizeselection, I always place the highest priority on the preoperative measurementsand potential tissue cover.  Finally,your verbal requests are factored into the analysis.

     We usethe quick-recovery approach, so click on the web reference link below to havethis explained and you can see the list of Quick-Recovery (Flash-Recovery orRapid-Recovery) Breast Augmentation articles from peer-reviewed surgeryjournals.  It is a surgical procedure thatuses special instruments and techniques to minimize tissue damage and avoidtouching the ribs. It causes far less trauma to surrounding tissue thantraditional approaches, and it dramatically reduces pain and recovery time. Inpublished studies of BA patients, 95-percent of women interviewed after theprocedure returned to normal daily activities within 24-hours. Quick-recoveryBA is not a “gimmick.”  These specializedtechniques, which actually speed recovery and get you back to your dailyroutine, kids and work, are published in our plastic surgery journals.  Because these PS journals are “peer-reviewed”and edited, they are the gold-standard in our field as being valid science.Therefore, these are sound techniques, not marketing hype. 

     Be sureto see only a board certified plastic surgeon (by ABPS - The American Board ofPlastic Surgery) who is a member of ASAPS (The American Society for AestheticPlastic Surgery) and or a member of ASPS (The American Society of PlasticSurgeons).  Also, ask if the PS has anestablished, high volume breast augmentation practice, performing severalhundred breast augmentations each year.  Be sure the PS has been in practice for awhile, about 20-years might be a good gauge. Does the PS offer all three incisions? Discuss the implant type (gel or saline), shaped "gummy bear"or non-shaped, smooth or textured, implant pocket (over or under the muscle)and the "quick-recovery approach." Ask to see their before and after photos if you didn’t see any on theirwebsite.  If they are experienced, they should have several 100 breastimplant patients for you to view.  I would also recommend that your doctoroffer you the chance to talk to past patients who would be happy to discusstheir experience with you.  You need to feel comfortable, so make sure theenvironment is safe as in an accredited surgery center.  Also, ask a prospective surgeon if he or shehas ever published journal articles in professional peer-reviewed journals,which they can provide you.      All the best, “Dr. Joe”

Golly, you've cast your question as if it is a choice between your wish and his/her recommendation! You're overthinking this!Your job is to accurately convey your goals to your surgeon, and then let the expert best choose how to achieve your desired outcome, which should not be letters (cup sizes, which are all different by different manufacturers as you accurately noted) nor cc (which most women are NOT comfortable or intuitive in discussing). It's what implants plus what the patient's own breasts 'bring to the party" equal the desired "look." For an "average" size woman (say, 5' 4" and 120 lbs), it will take about 200-250cc to equal one bra cup size, depending on where you buy your bras. For 4' 11" and 93 lbs, it may take less than 200cc.But that's why it is so important to convey your goals, better in  photos than in letters. And to have a frank discussion about redo surgery costs if you end up wanting a different size than everybody initially agrees upon. The surgeon's goal is to make you happy, not to get you to comply with his/her wishes or recommendation. But you have to walk that fine line between trying to "do this" yourself and actually trusting your chosen professional. After all, s/he's done this a few hundred or thousand times, and you've done this . . . right, nada. So while being you're own advocate and second guessing your surgeon's advice is all fine, have you really had the discussion, looked at goal photos together with your surgeon, sized with implants in a bra or stretchy top, and then had MORE discussion.Now, having said all of that, and assuming you are "average" height, weight, and "full B is really "full B," I think you ARE closer to correct at 400cc than your surgeon at 300 or 325cc. Depending on more of that discussion and seeing goal photos and sizing data, I might even recommend 450cc or more. Realize the differences between 300 and 325cc sizes SOUND large, when in fact 25cc is LESS than 2 tablespoons. And the difference between 325cc and 400cc is 2 1/2 ounces (5 tablespoons). Put 5 tablespoons of water into a drinking glass and try to visualize just how much breast volume that would add. (ANSWER: not that much. In fact, barely visible.) So keep your perspective. Too many plastic surgeons will "add an implant size" thinking it will make a visible change, when in fact it takes about two implant sizes to equal the least visible change.A lot of sizing accuracy depends on your present height, weight, and actual breast size and careful measurements. That's what an ABPS-certified plastic surgeon's job is. Perhaps you need more discussion, or even another consultation or two elsewhere. It shouldn't be a "battle;" it should be an agreed-upon and comfortable collaboration! Best wishes! Dr. Tholen

Ultimately the implant sizing is up to the patient assuming that they understand all of the risks and benefits of a particular size implant, especially in relation to their anatomic starting point - breast base width, chest width, cleavage, amount of breast sagging, etc.  I would recommend seeing an ASPS board certified plastic surgeon in consultation.  They can help you select the appropriate size implant to help you approximate your goal appearance.  Hope this helps. 

I think you have brought up an important question.  That is, who makes the final decision regarding the implant size that is chosen?  Every Plastic Surgeon has his or her own philosophy about this, but I will give you my perspective.  I think it is best treated as a group decision between the surgeon and the patient.  In my practice, my cosmetic consultant and I spend a good deal of time talking to the patient during the initial consultation trying to determine exactly what her goals are. Looking at "goal" photos helps us to understand what she is looking for.  I stress to them that a specific size gives each person a different result.  For example a woman who is 100 lbs and 5'0" tall will get a very different result with a 300 cc implant than woman who is 150 lbs and 5'9" tall. For this reason, I don't think that the calculations that you mentioned are very accurate.  During the exam, I take several measurements that help me determine which implant sizes will fit best for that individual. By that I mean which implants will provide a natural result while minimizing the risk of short or long term complications.  In general, women who have had children can accommodate larger implants than women who haven't, because there skin is less tight. We then assist the woman in "trying on" sizers with a bra to see what look they like.  Assuming a woman wants an implant size that is larger than what I recommend, I will review the increased risks associated with their choice.  This usually includes an increased risk of numbness or pain as well as an increased risk that the implants will move out of the ideal position over time.  In general, I will allow them some leeway, however if I feel that an implant is so large that it puts her at increased risks of a bad outcome, I will not agree to using it.  It is best to have an in person consultation with an experienced, board certified plastic surgeon in your area.  Best of luck.  

It's hard to determine your best implant size without specific breast measurements and an in person exam. Remember to choose a board certified plastic surgeon who actually takes the time to measure you and examine your breast pocket. The goal of breast augmentation is to optimally fill your breast pocket, not to overstuff or understuff it. At my practice, we utilize a series of 5 breast measurements that help me determine the implant size, which in turn helps me deliver a 24 hour recovery. Do your research and choose a surgeon who takes the time to sit down with you and discuss your goals/expectations to determine the best size for you. Remember that sizers will only give you a rough estimate. Good luck!!