Do I Have Reason to Be Very Upset? I Was Told I'd Increase To A D Cup But Only Increased To A B Cup.

I am 5wks post-op. I am 41 yrs old, 5'6" and 218lbs. My chest is 38 1/2" around. I was a tight 38A before my BA. I chose 457cc and 492cc with a nurse (not the PS) based on how they looked, then took pics. PS came in, said those sizes would be a D cup, but he never once looked at the pictures or discussed with me the actual look I wanted. At post-op appt., I stated I was very upset they were so much smaller than pics, and all he said was "you picked them out,and thats what I put in!" Am 40B now.

Doctor Answers 6

Unhappy with breast implant size

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Although you chose relatively large implants, you have rather thick subcutaneous fatty layer in your breasts, chest, and abdomen, and it takes larger implants to give you projection.  Implants do look a little larger when trying sizers on in a bra than they do in your tissues, and the thicker your fatty layer, the more the discrepancy.  It looks like your surgeon did a good job with your surgery, so the problem comes down to a problem with communication.  I never guarantee a cup size...there are too many variables and no standardization among bra manufacturers.  By the way, it takes a lot more implant volume to fill out a 38 D than a 32 D.  And if you are wearing a 40 B now, you may be a 38 C now (since you wore a 38 before, not a 40, and this measurement should not have changed)

Breast implanta

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I would add to the other comments that there is also a difference between breast size and bra size. You are now wearing a 40-B which is essentially the same as a 38-C. The result does look good and another discussion with your surgeon is warranted

Feeling upset after surgery

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It is certainly understandable that you are upset after your surgery since your expectations were not met. And it sounds as if you and your surgeon are not communicating very well which can also be upsetting. Even though your breasts are not as big as you expected, the pictures show that there has been a definite increase in size and improvement in shape. Going from an A to a D cup size is challenging at best and if that is really your goal, then you may very well need a staged procedure with a change to larger implants at some point in the future after your skin has had a chance to stretch out and relax. I recommend to my patients who want that amount of change in their breast size to wait at least a year between surgeries. And if you can't establish better communication with your surgeon, you may want to see other surgeons and find one with whom you feel comfortable.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

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You should not be upset

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Your surgeon has done a good job. Your pre surgery pictures show very restricted and asymmetrical breast.Your surgeon has used large implants . The only problem is the misunderstanding about the final breast size and your expectations.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 153 reviews

What to do if you chose the wrong size breast implant

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We frequently warn that it can be a risk to choose your breast implants with no experience. Also, you cannot know how an implant will look by placing it in your bra. The 457 cc implant on the outside will not look the same on the inside. You tried to show your surgeon how you wanted to look and he ignored you, a red flag. If anyone else finds themselves in an office where they 'just put them in' your experience should be a lesson to them.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast implant size/cup size?

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Thank you for the question.

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

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.