How much smaller than my BWD can my implants be? I have a Wide BWD but I’m intimidated by heavy cc’s. I don’t want sag!

Thanks for your question. Your Base Width Diameter determines the maximum size of implant you can accomodate before the edges become visible beyond the footprint of your breast. However you can go any size smaller than this. If you anyway have some volume in your breasts then it should cover the implant well and not be visible. The main exception is if you have very empty breasts then the implant may be visible underneath, but it doesn't sound like this in your case.  In cases such as yours I tend to use smooth round implants which can then easily slide in through a small 3cm incision in your breast crease. 

I appreciate your question!

After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon 

#RealSelf100Surgeon

#RealSelfCORESurgeon

Profile terminology will vary from one manufacturer to the next. The terminology matters less than the correlate dimensional measures.
As one goes up in profile the footprint or BWD of the device will shrink and the projection will increase for a given volume. I have found that full profile Allergan implants correlate closely with high profile Mentor implants. These devices exhibit higher projection than similarly sized moderate (+)/moderate profile devices. Ultra high profile is simply the next step upwards in projection.
Patients are encouraged to stay within the boundaries defined by their BWD. This is the best way to avoid the dreaded "fake" look. I generally recommend that patients with smaller frames who are seeking more than a modest augmentation consider a higher profile device.The higher profile device will impart greater projection and thus a less subtle result but will allow for a more significant augmentation than a similarly sized Mod/Mod+. Thus, the ultimate question is one of volume. Is the volume you can achieve via a similarly sized Mod + profile implant adequate to reach your desired goals. If not, a HP will afford you more volume at the cost of subtlety.
With regards to your specific question, moderate plus is the most common profile in my practice. It allows for the most reasonable volume in given BWD. When sizing my patients, I determine a BWD and then allow them to select a volume from across the different profile options (with most selecting Mod (+)). For a given BWD a low profile implant will have the least projection and volume. While this profile, in my practice, is less popular, you might consider it if volume/weight is an issue.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Thanks for your question. It is true that your BWD or Base/Breast Width Diameter is very important. Your BWD essentially determines the size of implant that your breast can accomodate before the implant starts to become more noticeable beyond the natural shape of your breast. It is hard to say without seeing you in person but it would probably be worth you asking to have a proper sizing appointment where you can try on different shapes and sizes of implants which will not only allow you to see how they look but you can also feel how heavy they are.You can calculate yourself averagely how heavy different implants would weigh; 
A quick way is to take the weight of both implants and then divide by 426.67. Example:
300cc x 2 = 600cc 600cc ÷ 426.67 = 1.406 lbs.

Dear Nervousgirl, This whole process can be daunting and overwhelming, especially when you get in to the details like the base diameter.  I agree that the base diameter is actually the most important thing when looking at implants, but mainly because you do not want to go too wide as this can cause problems.It is less of a problem to go narrower than your breast width and if you are worried about having large implants, then you can choose a lower profile implant, which for a given base width will be smaller than a higher profile implant.I would not worry about it too much, the most important decision is in choosing your surgeon.  Look for a fully qualified plastic surgeon by looking for FRCS(Plast) after their name and look at some before and after photographs of the different shapes and profiles of implants to try to get the look that you are after.Good luck.

Thank you for the good question.  There are no hard and fast rules when it comes to diameter of breast implant versus diameter of breast (band width). In other words, these measurements are useful but are only one of the many factors come into play when it comes to selection of appropriate breast implant size/profile. I agree with your thought process. My very general advice when I first meet patient seeking breast augmentation surgery:  aim for ONLY as large as necessary to achieve  an outcome they will be pleased with long-term ( "bigger is not necessarily better").
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
 Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.

Dear Nervousgirl,  Breast base width is important in the sense that implant base width should never exceed it. But as far as low much lower it can be -ideally it is determined during personal exam by plastic surgeon . I check the breast tissue thickness and base it on that. Implant width should ideally be  1- 3 cm less than breast width. In your case specifiaclly you mention that diamete is 14-15 cm . Firstly this need to be measured by an expert again and iven if it is-there is no problem. 300 cc moderate profile implants have diameter of approx 13.5 cm and in fact you can go for lower volume if you choose low profile implant. For the same volume 4 different profiles are available and base width is widest and volume least  for low profile. In short you should just not worry about it and should  consult a board certified plastic surgeon in person.