Implants sizers are not designed to be put in bras to get an idea of what certain implant sizes will create after breast augmentation. It’s a notoriously, unpredictable way of determining implant size. Putting an implant in front of your breast it’s very different than the implant sitting on your rib cage behind your pectoralis muscle Each plastic surgeon will have their own way of determining what size and shape implants to use. I’ve seen plenty of plastic surgeons, who either used sizers or filled Ziploc bags with water. My personal preference is to work exclusively using before, and after pictures of previous patients who had similar breast characteristics to my patients. Patient come down and pick up the type of results they’re hoping to achieve. During surgery are use sizers to determine what implant size will create an outcome consistent with the pictures. Patients have reviewed with me during the consultation in regards to their optimal results. I bring a large selection of implants available to choose from during surgery and use sizers to determine which implants will create, the outcome the patient have shown that works for them. I find pictures to be far more accurate than any other method. When it comes to a Breast implants pictures actually worth 1000 words. There are three basic variables to determine the quality of breast augmentation surgery. The first is the patient’s candidacy for the procedure not all women are ideal candidate for breast augmentation. Understanding your candidacy, for the procedure is best done by having multiple inperson consultation at which point is efficiently, talented and experienced surgeon, should be able to point out any variables that make you a better or worse candidate for the procedure. For example, women who have a highly divergent nipples should be told that augmentation will exemplify the divergence. The second variable is creating a correct implant pocket, minimizing the chance of implants bottoming out or riding too high. The third variable is choosing the correct size and shape and type of implant. Individuals who get quality outcomes typically have all three of these variables in their favor, and those who are unhappy with their outcome, and typically have their outcome explained by one or more of the three above stated, variables. There’s a little patience can you do it regarding their own candidacy for the procedure. With patients do have control over its provider selection at some degree implant choice. As I stated, previously, my preference is for me to make the decision regarding the final implant, based on having a clear understanding of what the patient is trying to achieve. I generally then take ownership of my decision made during surgery, but I found that this is the most accurate way of getting results consistent with what the patient have requested. each plastic surgeon will have their own method of choosing implant shape and size. There is no right or wrong, and each provider makes their decisions on how to practice the art of medicine based on their understanding of how to do this best. By putting the decision of implant size on the patient, the surgeon may feel that they are not responsible for the decision of which implants were used. To me, the surgeon is the one who has the most experience and is the best equipped person to choose the final implant, size, shape, and type. Obviously, patient’s desire to have saline or silicone implants need to be respected, but those with the best fund of knowledge are probably in the better position to make final decisions based on clear and open communications regarding the final outcome. Generally, speaking implants will look somewhat smaller when placed behind the pectoralis muscle compared to in front of the breast. The following are some general guidelines for patient to find the best provider for their needs. To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider. There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery. Best, Mats Hagstrom, MD