My PS will not talk about cup size or sizers!! Any suggestions?

After 4 children and breastfeeding all of them for 18 months each I am now left with deflated A cup breasts. I am considering BA only to restore my look of a full B prior to children. I am 5'4 inches tall and 124 pounds. I had 2 consults and the physician that I am considering is known as a great plastic surgeon. However, for BA he does not use sizers in the bra since he does not believe they are accurate and only goes by a "wish picture" from you. He won't talk about cc's either.

Doctor Answers 21

My PS won't talk about size, just uses wish picture

     At one time, there were not external sizing systems  or computer generated simulations of breast volume and the "Wish" picture was a reasonable choice to get an idea of what a patient wanted.  Now, however, the external sizing system (Mentor) and the computer simulations are simply better than any "wish" picture because YOU are the subject and not someone elseThe techniques demonstrate how YOU will look with a certain volume, not how someone else's breasts look.  I'm surprised that your Plastic Surgeon won't discuss volume with you.  You may want a second opinion.


Toledo Plastic Surgeon
4.9 out of 5 stars 34 reviews

Cup sizes are not standardized!

Hello! I share your frustration-- this is one of the hardest parts of the whole process.
I do discuss cc's but cup sizes are not standardized-- so it really is impossible to say for sure!  Using pictures can be deceiving too-- and it depends on the angle, the distance, the lighting and other factors. I do think one way to help decide is to use sizers-- but even this is not perfect and cannot predict your result exactly. I hope this helps!
Good luck.

Anne Taylor, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 35 reviews

The right size for you

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.

#breastaugmentation
#findingtherightsize
#BA

Breast Implants

Hi Twins,
Yes, this is one way to approach the decision.  Please see the excellent answer below by Dr. Grawe.  I used to do this with my patients because Cc and cup sizes can be inaccurate.  But, here are a few tips for you because this is perhaps the 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 consults to be sure there is careful communication. We do a full exam in front of a full-length mirror taking six exact measurements.We put 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". 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 patients that 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 for flattening 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 your tissues.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 surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan.Keep in mind larger implants tend to have more problems over the years.Since silicone implants wrinkle less than saline implants, they might be your best bet.
You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and see what you think.Implant size must square with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wall are taken (seven in total). Implant size selection has been an issue of much discussion.
Therefore, I use a wide variety of methods, but the implant size is always established preoperatively.Also, patients are advised to bring reference photos demonstrating their ideal size and shape. A photo album of patient pictures is maintained to assist them. These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery. In determining the final size selection, I always place the highest priority on the preoperative measurements and potential tissue cover.Finally, your verbal requests are factored into the analysis.
We use the quick-recovery approach, so click on the web reference link below to have this explained and you can see the list of Quick-Recovery (Flash-Recovery or Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery journals.It is a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs. It causes far less trauma to surrounding tissue than traditional approaches, and it dramatically reduces pain and recovery time. In published studies of BA patients, 95-percent of women interviewed after the procedure returned to normal daily activities within 24-hours. Quick-recovery BA is not a “gimmick.”These specialized techniques, which actually speed recovery and get you back to your daily routine, 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 sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). Also, ask if the PS has an established, high volume breast augmentation practice, performing several hundred breast augmentations each year. Be sure the PS has been in practice for a while, 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 their website. If they are experienced, they should have several 100 breast implant patients for you to view. I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you. You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.
All the best, “Dr. Joe”

That's a little odd, but not a deal-breaker.

If I had it my way, I wouldn't discuss cup sizes either, but I do because that's what people understand.  Also, I think you have a right to know the size of the implant prior to surgery.  Going by a "wish pic" is a little weird.  It's nice for guidance and discussion, but no one can guarantee that it will be your result.  Maybe you should look around a little.  You need to be comfortable and knowledgable of the plan.  It's your body! Good luck.

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 15 reviews

My PS will not talk about cup size or sizers!! Any suggestions?

I appreciate your question.

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.

Silicone will give you a 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 more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are 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.

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

My PS will not talk about cup size or sizers!! Any suggestions

I will admit that is unusual. It is very difficult to transfer an appearance in a picture to the implant size the patient needs as there is not enough information in terms of breast measurements. I actually have my patients sign a paper with the size they have agreed to before surgery. I would ask the surgeon if he is going to pay for the second surgery if he chooses something too big or too small.  In the end, it is you that needs to be happy, not the surgeon.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

What is the right implant size for you? (Who is the best surgeon for you?)

Choosing breast implant size can be done in a number of ways; using as many of them as possible only increases the information I utilize to most accurately achieve the “look” each patient desires. Avoiding this discussion pre-operatively only increases the likelihood of the "You did NOT make me the size I wanted" discussion later! Perhaps asking your surgeon what happens then, and who pays for what will stimulate more discussion pre-operatively.

Of course, patients often have input from friends who have undergone this operation, have a "great result," and have ____cc implants. "Get those!" she tells you. But you probably don’t know what proportion of her present size is her natural breast tissue, and how much is implant. Unless your breasts exactly match your friend's pre-operative breast size (doubtful), and the rest of your chest wall, breast base, and anatomy are the same (impossible, unless she is your identical twin sister), you will probably need different implants added to your own tissue to get similar results.

Determining what size is best for you is even more difficult if you rely on friends who advise to “not go too large” or you will “look fat,” be top-heavy, or have a "porn-star look." Compared to whom? Or is she just a bit jealous? I have seen entertainers, models, and everyday women with breasts of all sizes and shapes--many of whom ask me to give them something different: bigger, smaller, higher, or with an improved shape. What is best for one is definitely not best for all.

Breast augmentation is a personal choice, and while a friend’s input can be helpful, you should choose a size that makes you feel good about yourself. For MOST women, the size you choose is not only possible, but perfect for you! Remember, you should never have surgery to please someone else, or to try to conform to someone else's opinion.

Plastic surgeons that perform lots of breast enlargements have extensive experience in helping our patients choose implant sizes that are compatible with individual anatomy. Every one of us does this slightly differently, and some surgeons even decide for their patient. Sounds like your surgeon? Does he read minds?

But what about the patient's wishes? Every patient has a "perfect size" in her mind's eye, and all the surgeon needs to do is figure out what that size is, and whether or not it will match appropriately with the patient's chest and breast base dimensions, skin and muscle capacity, position of the nipple-areola complex, as well as a host of individual anatomic factors. I start with breast examination, careful measurements (everyone is asymmetrical), and ask you what your goals are. Photos help with this step, but even stating cup sizes here starts the thought process. Based on these factors, experience plastic surgeons can determine if your requests can be achieved. For most patients, the answer is YES! If not, your surgeon should be able to tell you, and will try to figure out what CAN work, and how to best get CLOSE to your goals.

Some surgeons suggest rice bags or water-filled baggies to estimate ideal breast size at home. While many women find this cumbersome and do not wish to utilize these methods, there is certainly nothing wrong with either of these ways of estimating desired size.

One of the best techniques for choosing implant size is for the patient to bring photographs of models with the desired (final) breast size to their consultation, or at the time of surgery. The proper size implant to most closely achieve this appearance is then chosen in the operating room. (In our office, we stock all sizes and profiles of saline and silicone gel breast implants in our surgical center, we do not have to “order in advance” and can change based on your choices right up to the time of surgery). “Wish photos” have proven to be much more accurate than the patient requesting a letter cup size, or trying to find a similar person via internet search whose anatomy and/or results approximate your goals. Don't try to match your height, weight, or preoperative breast appearance to the photos, and don't use a stated implant size as a guideline for choosing your implant size—just find an “AFTER” photo you like.

Also, if your breast sizes don’t match (most women have some degree of asymmetry), we can choose different implant sizes and/or profiles to achieve as much symmetry as possible. In more severe cases, we can recommend appropriate procedures (such as breast reduction, breast lift, or other surgical options) to optimize size, shape, and position between more mismatched breasts. Implant choices can be made to help camouflage chest wall or other skeletal asymmetries caused by scoliosis, pectus excavatum, tuberous breasts, Poland’s syndrome, or other genetic syndromes.

However, trying on implants in a brassiere and stretchy top is another excellent way to provide some idea of desired final breast size and the implant volume needed to achieve that size; however, it is essential not to become overly attached to a specific bra cup size (B, C, D, etc.) or implant volume (400cc, etc.), since the implant size you like in a bra or top will always look smaller when it is under your own breast tissues and chest muscle.Typically, a woman who chooses a specific cc volume implant that she feels looks good in her bra will be disappointed (too small) after surgery if that exact volume implant is used in her body. This is because submuscular compression of the implants makes them look slightly smaller than when sizing in a bra. A good general rule of thumb is to add 50 to 100cc (10-15%) to the implant volume you feel looks good if you choose to size in a brassiere.In other words, if you like how a 400cc implant looks in a bra, it will take somewhere near a 440-460cc implant to look about the same size in your body. Final size and profile are chosen in the operating room where your surgeon can actually identify specific characteristics of your skin and muscle tone, chest wall (ribcage) configuration, and accurately measure your pocket diameter, not relying just on estimations of breast base width measured pre-operatively.

My office features a comfortable, discreet, implant sizing room where patients can try on actual silicone implants in a stretchy top. Comfortable chairs and plenty of mirrors allow you and a spouse, friend, or confidant choose what makes you feel the best about yourself. We then take this information, goal photographs, and any other input from you to help us provide you with the best outcome possible. It's a shame that your surgeon doesn't believe in using as many tools as possible to best achieve YOUR goals.

In general, for an “average” height and weight woman, 200-250cc equals about one bra cup size. A 12 ounce can of soda = 360cc. Most patients cannot even see a difference of 50cc (3 tablespoons and 1 teaspoon). Thus, 400cc implants will cause an increase of about 1½cup sizes to whatever breast volume the patient started with!

Ultimately, your surgeon will have to order or select the implants placed into your body. This is surgery, not trying on shoes or a blouse until you get the "right fit." Nothing used in sizing (including computer analysis) is "perfect;" only reading your mind and predicting your future acceptance of your new appearance would accomplish that. Perhaps you need another consultation or two. But at minimum, you should have the "What if YOUR choice is NOT what I like?" discussion. And the cost of re-operation policy. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 240 reviews

No discussion of size or sizers

The approach to breast augmentation can vary slightly from surgeon to surgeon. However, in my opinion there are a few basic principles that I believe most plastic surgeons will discuss. First off let me state, that it is difficult to guarantee a specific cup size, and most plastic surgeons will not guarantee a cup size. My rule of thumb is that 150 - 200 cc is approximately one size increase in cup size, but not a hardfast guarantee. The second is that external sizing systems, which I use, has been , in my opinion quite accurate as far as relaying the proper feedback information to patients in the mirror. After the appropriate measurements are taken, in conjunction with the size of the external sizing system, an implant can be chosen that will closely help you achieve the look and goal you are seeking. The final implant  that is chosen does have a specific volume , so a discussion about cc's is a must. Whether this a range or an absolute number differs from surgeon to surgeon.  I do not have experience with the 3D imaging systems so I cannot comment on it, except to say that if used properly can be extremely helpful. As far as the "Wish picture" is concerned", I find it helpful to get an idea of the look the patient is interested in achieving, but the issue is, as the other surgeon explained is that every body type is different, so to simply use the "wish picture" , I  feel is not adequate enough. Hope this helps. Good luck

regards,
Dr. Ravi Somayazula 

Ravi Somayazula, DO
Sugar Land Plastic Surgeon
4.8 out of 5 stars 53 reviews

Sizing of implants

 In my area of the country, it would be very hard to tell a patient that we could not show them at least a fair representation either with 3-D imaging or the mentor sizing system what the likely outcome would be. I do agree that placing a real implant on top of your breast and putting that into a bra will overestimate the actual size of the same implant placed below the muscle. The mentor sizing system uses a shell that when placed over the existing breast inside a bra, will better represent what the corresponding real implant will look like. The 3-D imaging system from Vectra is the best way to visualize what the result would be. In my hands it's been very accurate. I agree that no one can promise an exact cup size as cup size seems to be very variable between different bra manufacturers. good luck with your breast augmentation. A

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.