What's best for me?
How to Pick the Right Size and Shape of Breast
One of the more frequent questions I'm asked as an aesthetic plastic
surgeon for patients considering breast implants is "how do I know what
size, and shape I need?” The answer
to this question has changed dramatically throughout the 25 years that I've
been doing breast augmentation. I've also learned that the words that patients
used to describe either what they want or don't want can be completely
misleading into what I interpret their meaning to be. Therefore, I like to
request that our patients considering breast augmentation bring in photos of
both what they think they like and what they don't like. There seems to be a
multitude of sources on the Internet where these photos can be downloaded. By
looking at the patient's desires, I get a better understanding of what they
want. We no longer recommend that we place the exact implant on top of the existing
breasts and then place a stretchy bra over it to give us any idea what that
exact same implant under the muscle would produce in size. That method, in my
opinion, will always over represent what the actual result will be. If you are
going to use a sizing type method, then Mentor makes a shell sizing system such
that, when the shell size corresponding to the implant that it represents is
placed over the existing breast and in a bra, it will better represent what
that size implant under the breast and muscle will look like. We've also used
3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this
method, a three-dimensional photograph of the actual patient is taken and can
be seen on a large screen television by both the physician and perspective
breast augmentation patient at the same time. We then can place all of the
different implants that are available under that image and decide what size,
shape, fill ratio, and height to base width relationships will look best for
each patient. Silicone gel breast implants come basically into shapes either
round or shaped. They also come with either a textured or smooth surface. In my
mind, there are advantages and disadvantages of every scenario and combination
of those choices. Most of the time a round smooth implant placed under the
muscle works very well for breast augmentation patients. It's then very simple
to just look at size and ratio projection to base width and select the perfect
implant for that patients shape and desire. Sometimes we would like to use a
textured surface implant. Here the advantages are that the textured surface
implants tend to migrate less in the pocket, as there is some frictional
resistance to motion. Another advantage of textured implants is that the
capsular contracture rate, especially when implants put above the muscle, is
less than for smooth wall implants. Shaped implants, because we do not want
them to turn in the pocket, are always textured. My planning method to optimize
the best implant for each patient is begun with a measurement of the base width
of the breast. We would then like to subtract about a centimeter and a half
total off of that number so as to have coverage of breast tissue over the
implant. We then will have a range of implants whose base width matches that
number. If we go larger than that number, which sometimes patients will want,
we as plastic surgeons know that these larger implants can have more problems
down the line. For instance, larger implants may migrate below the crease which
one has to lower at the time of surgery in order to get the implant in. When
these implants migrate below the natural crease, they can create a second
crease in what we call a "double bubble". Large implants can also;
because of the pressure they put on the overlying breast tissue, thin that
tissue out such that there is less overlying breast tissue over the implant as
time passes. After we have the base width, our next decision needs to be what
is the ratio of the base width to the projection of the implant. Essentially,
there are usually four choices ranging from fairly flat which is called
low-profile, to progressively more height and less width with the same volume
of silicone gel, which is called ultrahigh profile. There are two profiles in
between which are the ones more commonly used and these are called moderate
profile and moderate profile plus. Common scenarios in which taller implants
would be desired may be in patients who want a larger look than their natural
base with would allow or have a fair amount of loose overlying skin that were
trying to hold up. For patients who want a more natural look, a moderate
profile or moderate profile plus shape is more desirable. There are also
anatomically shaped implants. Rather than being around these implants can
either be taller than they are wide or wider than they are tall. There are good
reasons in patients to use either. For instance, in the patient's with very
widely spaced breasts and a large breastbone, a shaped implant that's wider
than it is tall can help hide that a little bit. Another example of the patient
in who a shaped implant would be best, is that patient with laxity after
childbirth or weight loss. When the nipple is just at the level of the
inframammary crease, we can sometimes get away with a tall implant that is
anatomically shaped such that the nipple when is it at the lower two thirds of
the breast mound created by the implant still looks good and natural and may
obviate the need for a breast lift. By spending some time, long before the
operation takes place, using the Vectra® 3-D imaging method, we can decide what
type, shape, and ratio of width to height would best serve the patient's needs.
We can then avoid what is sometimes done which is the placement of sizers at
the time of surgery. These sizers, in my opinion, have a few negative
implications. One is that there is a cost inherent in using them and usually
multiple ones are needed to make a decision as to which implant would look
best. I also believe that placing sizers in and out of the breast pocket can be
traumatic to that pocket and can cause bleeding. For me, the state-of-the-art
in today's breast augmentation is to decide long before the operation exactly
which implant would look best using computer animation. A new wrinkle into the
choice of breast implants is that breast implants now come with silicone gel
that is filled to a higher volume in the shell where it is placed. This will
allow for a round smooth implant, for instance to collapse less in the upright
position mimicking more of the look of the shaped implant. When patients show
me a photo of a very rounded upper part her breast, I would likely choose one
of these higher volumes implants such as the Natrelle Inspira® silicone gel
breast implant. Often times patients will present with breasts that are of
different sizes. One of the options to correct this is to use breast implants
of different sizes in order to best create symmetry. One of the newer methods
to help in symmetry creation is to do what we call a hybrid breast
augmentation. In the hybrid breast augmentation, the patient who has asymmetry
of the breast to begin can have matching silicone gel implants placed and the
overlying breast tissue can be made to look the same in volume and shape by
using fat grafting. In that way, no matter what the change in weight of the
patient is over time, the breast is more likely to have the same or similar
size. When it comes to symmetry, I like to tell our patients that they should
consider their breasts to be sisters that live across the railroad tracks from
each other rather than twins. With proper preoperative planning and flawless
execution of breast augmentation, this can be one of the most satisfying
aesthetic plastic surgery outcomes for both patients and physicians.
Perky, full breast augmentation. What is the best implant and incision?
Thank you for your questions regarding breast augmentation. The implant of choice will depend on your postoperative goals and the measurements of your breasts/chest. Your surgeon should discuss with you the differences between silicone and saline implants, round vs anatomically shaped implants, submuscular vs subglandular implant pocket location, and incision locations. You should also expect to be able to use a sizing system of some sort in your surgeon's office so that you are both on the same page as to your postoperative expectations. Based on your height and weight, I would expect to place your implants in a dual-plane submuscular pocket and likely through an incision in the fold under your breasts. To be sure, consult with one or more board certified plastic surgeons to discuss your options. I would be happy to see you for a complimentary consultation. Best wishes!
The right implant
Your question is a great one. It depends on the look you are trying to achieve and your breast characteristics. A good start will be for you to look at pictures on someones website and choose a look and size that may match your own. Seek a consultation with an experienced board certified plastic surgeon. Make sure he offers all the implants out on the market as it will give you a wide verity and will show your surgeon is a talented one that knows what he is doing and offers variety to his patients. Ask about the positives and negatives about each implant. Have a physical exam done by him. See a few surgeons prior to your surgery. There are so many types of implants with different gel, profile, shell etc. to choose from.
Best Implant and Incision for Perky Full Breasts
There are so many options including the implant size and projection as well as your breast base diameter and skin elasticity. You really need a thorough consultation with an experienced, board certified (ABPS) plastic surgeon to help you make these decisions. In general, I would recommend a gel filled high fill volume implants such as the Natrelle Inspira implant. Given your height and weight as well as your desire to have full breasts, I would recommend a full or extra full (high) projection implant. The implant base diameter should be roughly the same as your breast base diameter. As for the incision, different surgeons have different preferences, but the majority prefer an inframammary incision. These decisions will be made during your consultation.
Perky full breast augmentation
Thank you for your question. Because of the sheer variety of implant styles, sizes, and types it is difficult to recommend a specific one as key breast measurements of your chest need to be made, and an in-depth discussion of your desired goals needs to be had. All things being equal, I would recommend seeking a moderate plus or high profile implant with greater silicone "fill" such as the Natrelle Inspira or Sientra implants to attain a full, perky appearance. Hope this helps.
What you are describing could be accomplished with a high profile implant. You want to make sure the base diameter of the implant matches your base diameter. I recommend the Allergan Inspira extra full profile implant. I would also recommend doing 3D photographic imaging to visualize what a specific implant would look like on your body.
Breast augmentation questions
So much of what you are asking can only be determined with anti person examination. How big you can go, which implant, how close together they will be all depend on where you start. The most important thing to do before your consultation is do your homework. Check your surgeons websites. Make sure they are a Board Certified Plastic Surgeon, not a board certified ER Doctor who puts in breast implants for cash. Check their before and afters and look for patients similar to you. Smart Beauty Guide is a excellent resource to look for local board certified plastic surgeons who also are members of our aesthetic society.
Main Nashville there are many outstanding plastic surgeons who do excellent breast surgery. You should see 3-5 and pick whomever is not only qualified but that you feel comfortable with. No one plans on a complication, but you want a doctor you trust if that happens. Best of luck
Perky, full breast augmentation.
Thank you for the question. Online consultants will not be able to provide you with specific enough advice to be truly helpful.
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.
Given that your surgery is coming up soon, I would suggest that you spend additional time communicating your goals/concerns directly with your plastic surgeon, preferably prior to the date of surgery.
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” or "perky,full" 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 (and the attached link/video, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.
BA Implant type and Incision Location
Hello and thank you for your questions. I wish you the best in finding
the right answers and there are a lot of great answers and information on the
forum as well as on my website. Remember, it is best to see a Board
Certified Plastic Surgeon who can in person examine you, take key measurements
and go over with you your specific aesthetic goals. Bringing several photos of
your "ideal" look can be helpful as well. My consultation is done at
no charge, and with the consultation is a review and discussion about several things including incision
location, implant placement, implant size, shape, type as well as the expected recovery period. I take personal care of all my patients to ensure optimum results. There are several key differences and some similarities in the
types and shapes of breast implants. It is best to see and feel in person the
different sizes, shapes and textures of the various implants during a
consultation with a Board Certified Plastic Surgeon. Best of luck.
Benjamin J. Cousins M.D.
Board Certified Plastic Surgeon
Perky, full breast augmentation. What is the best implant and incision?
Sizing of breast implants will be determined by the width of the base of your breast which will be measured by your surgeon during your consultation. For more information please read the link below: