How do I decide on and articulate a breast size and shape for my reduction?

Question

I have my consultation for a breast reduction on June 29th and I'm worried I won't be able to decide and articulate what results I want. I'm 5'4", 180lbs (I've lost 40 and have about 40 to go), currently around a 42 F. I'm not sure if I'll regret going down to a C or if a D will not relieve my back pain. Any advice is appreciated!

Urmen Desai, MD, MPH, FACS · Answer

A lot of the final size and shape is determined by your pre-existing size and shape.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

David L. Kaufman, MD FACS · Answer

Thank you for your question. Your concern is a common one, as bra sizes vary from brand to brand, making cup size an unreliable way to talk about your ideal breasts. I suggest searching in magazines or online for women with your ideal breast size and shape, and bringing those images with you to your consultation so you and your plastic surgeon are on the same page about your cosmetic goals.

Ronald J. Edelson, MD · Answer

The best way to tell the surgeon how large or small you want to is to look through before and after photos of women that are similar to you.  The one thing you don't want to do is overdrive a breast.  I leave the breasts in the full side because they always go down in size over the next six to twelve months

Gerald Minniti, MD, FACS · Answer

Hello,Cup size is a poor way to articulate breast size after reduction or augmentation. A detailed exam with an experienced surgeon will allow you to visualize how much tissue should be taken and from what part of the breast. Be sure you choose an ABPS certified/ASAPS member surgeon with at least a decade of experience specializing in breast surgery. Best of luck!

Daniel Barrett, MD · Answer

Dear Lolaisvegan,determining the ideal breast size and matching that goal for the patient is the most difficult part of breast reduction surgery. It starts and ends with the patient. We have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Lastly, during the operation, we check in the operating room to see how the breasts actually look. You don't want to invest time and money into a result that is either too big or too small. After a consultation you will have a lot more information which can help you decide which size is the right for you. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Stuart A. Linder, MD, FACS · Answer

The final size depends on both your goals and your frame. Going slightly larger is usually the better choice as once the tissue is removed, it can't be replaced without an implant. Best of luck

Lisa Cassileth, MD, FACS · Answer

I find it very helpful if a patient can say what percent of the breast they would like gone. Like if they say 1/3 smaller, or 1/2 the size. I have a Vectra which is a 3D imaging system, which gives me a close estimate of the breast size at the time of the consultation. Then, in surgery, I just take off the right amount. For example, if the Vectra says you are 1000grams, and you say you want to be half the size, then I would remove 500g. Even without the Vectra your PS can still use the percent off on the appearance. Of course, there is still a lot of sitting up and checking in surgery to make sure it looks good. Finally, picking out your "Dream breast" size using a non-porn site like Getty images is helpful.

Tim Sayed, MD, MBA, FACS · Answer

Hello,As you probably know, bra cup sizes are notoriously inconsistent from one bra to another for any given person. One way we try to take guesswork out of the process of deciding on breast volume is to use 3D surgical simulation software. This allows us to take a 3D scan of your body, and "morph" the images by lifting, reducing, or enlarging portions of the breasts as appropriate. The tool can also estimate the amount of volume you have in each breast, and we can simulate subtracting certain amounts. While this is not a direct promise of a final result, it is a VERY useful tool for educating patients on how the result may look, and to help guide the surgeon in managing and meeting - hopefully exceeding! - expectations.

Larry Lickstein, MD · Answer

Congratulations on the decision to have a reduction.  The best approach is simply to discuss your concerns and your uncertainty with your plastic surgeon, and ask their thoughts.  An experienced reduction surgery will likely make some recommendation based on your the dimensions of your chest and your overall build, keeping in mind the goals of relieving physical discomfort while maintaining body proportion.  Consider reviewing before and after pictures online, searching for images of patient whose figure is similar to yours and has a result that you are hoping for.   Also remember two things:  first, every woman wears their bra differently, and different companies have different cup sizes.  In the end, the cup size, which may vary from brand to brand, is less important than how you look and feel.  Second, it is better to error on the side of leaving more breast tissue, as it is a simple matter to reduce more if necessary, but once excised, it is a complicated matter to increase breast size.  Best of luck!

James McDonough, MD (retired) · Answer

It is often difficult to explain just what you would like to look like.  Many people have a recollection of a time that they were the size and shape that they hope to be.  Others have a friend that they admire and sometimes they bring them along to the consultation. Most have a bra size that they have in mind, usually some combination of the size they are now and the size they were years ago.
Your physician will try to explain what you will experience. You may be temporarily taped then asked to put a shirt on to get an idea of the new size and shape. Occasionally a bra the size you wish to be can be put on backwards so you can judge how that cup size looks on your frame even though it is on your back rather than on your front.   Your physician has a vested interest in a careful explanation as it is much easier to explain before than after the operation.