BWD - 10.5. How much does your BWD truly limit you?

Question

I am looking to get a breast augmentation, and have had two consultations. 1 surgeon said I can not go higher than a 275 full profile Motiva, the other said a 320 demi profile would be the max. My breast width diameter is 10.5, and per the motiva chart that would be 230 in the demi profile, and 275 in the full. I definitely want demi profile ergonomix, but a 230cc will not give me the results I am looking for. Is going to 320 demi profile safe even though the BWD for that size should be 11.75cm?

Daniel Barrett, MD · Answer

Dear allieclay,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, 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. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

Having the right diameter implants will provide the best aesthetic outcome. Some patients who want larger implants will sacrifice this knowing that shape and contour will not be ideal. This should be discussed further with your surgeon.

Javier Parada, MD · Answer

Hi! Let me tell you. In breast augmentation, breast width is one of the most important factors when choosing implant size. With a base width of 10.5 cm, implants that stay within that width tend to look more natural and remain more stable over time.
Although a 320 cc demi-profile implant may seem appealing for added volume, its diameter is wider than your natural breast base. Choosing an implant that exceeds your base width can increase the risk of a breast that looks too wide, implant displacement, contour irregularities, or the need for revision surgery.
Rather than focusing only on cc’s, the goal is to balance your aesthetic goals with what your anatomy can safely support. In many cases, a slightly smaller demi profile or a higher-profile implant can provide better projection and a more natural, long-lasting result.

Donovan Rosas, MD · Answer

Choosing an implant size/style is an important decision which is best made in concert with your surgeon. Ultimately, options are based on a number of factors including:
-Chest dimensions: This point is crucial as the width of your breasts defines the available "real estate" on which the foundation of your augmentation is built. This "foot print" is the absolute limit with which you are dealing.  Too "large" is not so much the risk as too "wide." You cannot build a 3 acre mansion on a half acre plot. An implant which is too wide (exceeding the available space on your chest) will generally over hang laterally making it more noticeable and occasionally contributing to discomfort and nerve symptoms (numbness or tingling). This will also contribute to a more unnatural look.
-Tissue quality: This relates to size in the sense that the implant will be suspended by your tissue. Too large an implant may place took large a stress on these suspending tissues leading to healing problems in the short term and bottoming out in the long term.
-Patient desire (what is the look you are hoping to achieve?)
My role as a surgeon is to manage expectations and guide you towards a prudent choice which can satisfy these reasonable goals. Often times, a surgeon can guide a patient toward a size/cc range and patients will make determinations on implant style/profile. Patient seeking more or less projection, or seeking a more pronounced or subtle upper pole volume increase can be guided toward an implant which will help them best achieve their goals. Additionally, technique variations (sub muscular vs. sub glandular) can also aid in obtaining the look you desire.  
There are a number of tools available to help guide patient/surgeon decision making including sizers, 3D imaging and goal photos. Each modality can help better communicate your goals to your surgeon and vice versa.
Ultimately, it is important to not marry oneself to a particular "cc" as oppose to a particular "look." 
With regards to your specific question, respecting the BWD is important but small variations are unlikely to have significant impact. Exceeding BWD is not a question of safety but rather shape with overly wide devices contributing to a mismatch between implant and frame. 
Communication is key as you and your surgeon create your custom surgical plan. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Ted Eisenberg, DO, FACOS, FAACS · Answer

Choosing the right size and profile breast implants for you. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice for over 30 years and breast surgery and revision breast surgery is a large portion of my practice.  I truly believe that the emphasis on breast width is way overly done.  There should not be much of a limit to how large of an implant that you can place.  You should easily be able to get in the high 300s or low 400s.  Do not let an experienced surgeon tell you otherwise.  Best wishes to you.

Mehmet Ozdemir, MD · Answer

Hi and thank you for your question.A full assessment of your tissue, skin elasticity, and chest anatomy is essential to determine what size can be safely accommodated while still meeting your aesthetic goals. I hope this helps.

BWD - 10.5. How much does your BWD truly limit you?

Answers (7)

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