How Can I Pick aN Implant Size? Surgeon Wants Me to Choose.

I have 400ccs with diam.of 13.1 and proj of 4.0 now. I was a small B and now am way too big for my athletic lifestyle. I would like to go saline. My goal is to go to a full B and shape my natural breasts. I can do a small C but stay in the 150-200 cc range. I want to look natural but no explant. I Think I need to o/fl to avoid rippling (correct?). how do I choose my new diameter and projection? The proj/diam is too much but I don't want it to look way separated.

Doctor Answers 11

Size not the only factor

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The goal of breast surgery is to produce beautiful breasts.  If you are dissatisfied with the appearance of your breasts because they are too large, then you wiil need to reduce the size of the implants.  However, implants are just one aspect of making a beautiful breast.  Equally are important are the shape of the breast, position on the chest wall, the position of the areolas, the cleavage, symmetry, skin tone and volume.  Instead of focusing on volume, you may need to consider a lift.  A lift can be done through a circumareola incision, which hides the scar at the areola-skin junction.  Through this incision the implants can be removed, your natural breast tissue can be reshaped to produce upper pole fullness and elevated on your chest wall.  The goal is to align your implant, your natural breast tissue and your areola all at the same horizontal level, high on the chest wall.  This will give you the most projection and natural look that you desire.

Best Wishes,

Gary Horndeski, M.D.

Resizing breasts

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Sizing is the most difficult part of breast augmentation surgery because it involves a leap of faith, ultimately, and a decision about the size at which you will be comfortable.  I do not think that 150-200 cc will produce a small size, although without a photo and knowledge of your starting point, we are all conjecturing.  Without evaluation in a consultation, it is impossible to say whether lowering implant size by almost 250 cc will produce rippling.  To avoid excessive projection, a moderate profile implant would be best.  Please post photos for more specific responses.

Breast implant exchange and sizing

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This is a discussion best had in person and after an exam or pictures at the very least. Having said that, you should be able to communicate and discuss your desires with your surgeon and then have him recommend what's best to achieve those goals. You mentioned a change from silicone to saline, not sure why you have decided to do this. In most patients downsizing, I newly recommend textured round base anatomical silicone implants made by Sientra to avoid droopiness due to the reduction in size. Please discuss this option with your Board certified plastic surgeon.

Choosing Implants

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I think you need to find another PS who is more helpful.  Sounds like they want you to choose so they won't be wrong.  I choose implants based upon profile and BWD. If you have a lot of breast tissue then the absolute width of the implant is not as important.  I do not overfill implants as this can create more skin rippling is some patients as it adds more weight.  Over filling will also give you a rounder breast and it does not sound like you want that.

Communication is the key when downsizing implants

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Each surgeon will have preferrences when it comes to implant size and projection, and when downsizing it can be harder to work with 'trial sizes' as implants are already in place. The key will be good comunication with your surgeon, especially through photos to give a clear idea of the look that you want. Choosing your own implant? Seems like a tall order when you have such a limited experience and we suggest leaving it to your professional.

Implant Size? Surgeon Wants Me to Choose.

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I find that downsizing an implant is the most difficult sizing decision. Patients with no implants seeking enlargement can try on implants, and I find that more useful than photos, etc. Patient with implants wanting to be larger can use raw rice in a stocking an estimate how much larger she wants to be.
There is no physical aid that can help in choosing an implant when downsizing, so communication is more essential than usual.

I am not sure why you want to switch to saline, especially given your concern for rippling. This is less common with silicone, and the gel implants will feel more natural.

In terms of implant diameter, you want to stick to the breast base width, which is probably close to the implant width of 13.1 cm. You will probably want to go with a lower profile implant, which the companies call "moderate profile."  If you go with 200 cc, the width may be close enough to not require any alteration in the pocket, whereas the 150 cc is over and inch narrower than what you currently have. 

The implant size choice should be a collaborative endeavor, with the surgeon choosing the implant based on your goals. There will be no guarantee of cup size whoever chooses.If you have already had your pre-op visit, I think you need another.

Thanks and best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Work with your surgeon to determine implant size and type

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There are certain anatomical measures that need to be considered as you know, especially base diameter, but ultimately the patient has to be comfortable with the choice of implant size. If you want the smallest size implant that still fits your base diameter, then a low-profile type would be best. Cup size is an inconsistent way to measure breasts. For thin athletic women, silicone gel usually feels more natural, especially compared to overfilled saline.

How Can I Pick aN Implant Size?

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This is an all too common question. In my opinion you are paying your surgeon for his skill and experience. If he is unwilling to guide you in implant choice with all his experience, how can you be expected to pick the device? Maybe you need to see someone else for a second opinion. BTW, overfilling a saline implant does not prevent rippling.

This is a group effort

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Talk to the doctor, this is a conversation and it needs to be between two people. You can go smaller and still look good.

Surgeons need to guide you through this process

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I would agree with Dr. Pousti that communication is key.  Some surgeons like to see photos of what you like and dislike.  I like this method.  While no surgeon can make you look exactly like a photo, I feel this helps.  I do not feel that the patient should be picking an implant.  You have never operated on someone and do not know what is involved.  Despite looking at lots of photos, it would be impossible for you to properly make this decision.  If the surgeon is asking you to tell him what size, he is likely looking to hold you responsible for the outcome in terms of size so that when you are too big or too small he can say, I used what you wanted.  Find a surgeon who understands your goals and desires and has enough experience in breast surgeon to tell you what will work and why.  Good luck!

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.