BWD and implant size, what parameters do you use to guide your patients and why?

I appreciate your question!

After performing hundreds of breast augmentations, I have found that 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. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you 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 softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is 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. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

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

Board Certified Plastic Surgeon 

#RealSelf100Surgeon

#RealSelfCORESurgeon

It's a good question and every surgeon has their own preference. I use implants with the same base diameter, or up to 1 cm narrower, than the width of the breast. Of course dimensions are not the only factor when sizing implants. A combination of measurements and each woman's goal "look" helps us choose the ideal implant for each patient.

The implant has
to fit YOUR body dimensions. The more you deviate from the proper fit,
the more fake your breasts will look.
Surgeons use what is called
tissue-based planning. The planning takes into account the effects of implants on tissues over time,
risks of excessive stretch, excessive thinning, visible or palpable implant
edges, visible traction rippling, ptosis (Sagging), and breast tissue wasting.
Overly large implants are associated with all the aforementioned complications
To determine the final implant size, breast
measurements need to be made: 
base-width, skin thickness, breast skin stretch and
nipple-to-Inframammary fold distance. The combination of these measurements will
help determine tissue coverage and the required implant volume to optimally
fill the breasts. If the skin covering your breasts is stretchy (>2 cm), or
if your nipple-to-inframammary fold distance is greater than 9.5 cm, then more
volume is needed for the optimal fill. Of course, your preferences will also be
taken into account.
I would also like you to know that surgeons trying to achieve long-term aesthetic results would often avoid choosing an implant diameter bigger than the base width of the breast. In fact, the implant diameter should be at least 0.5 cm shorter than the base width of the breast to make sure that the implant is not wider than existing breast
tissue. Having an implant that exceeds the breast boundaries places undesirable pressure on the surrounding tissues that become apparent in the long term.Now that you may acknowledge that the base width of the breast is just one measurement that is included in the
implant sizing process, you should know that it does provide the initial starting volume for
sizing purposes. For example, if you are 14 BW - then according to the implant sizing guides the starting size ranges without other measurements in the context of filler (silicone/saline), and profile are:
BWD 13.5-14 = 445-485 ccs for smooth round moderate profile silicone
implant.
BWD 13.5-14 = 560-605 ccs for smooth round full profile silicone
implantThe range of the saline implants is more variable and personalized.A key measurement that helps in determining the profile and implant size is skin laxity. Breasts with tighter skin require a smaller implant volume and a smaller profile/projection.  Please seek out a board-certified plastic surgeon to form a
personalized plan for your breast augmentation.
Hope this helps

and I am not handcuffed by your natural breast width as some take the rule of not exceeding your natural width to an extreme.  Width of the implant is used to help diminish the distance between the mounds (you don't want symmastia) and provide side boob.  This is done within the guidelines of what my patients want as not everyone likes side boob but most do want less space between the mounds.  So implants are selected accordingly to what the patient wants to achieve.  In your case, I would need to know how much space is between your 14cm wide breasts to determine just how wide an implant you could take.

Thank you for the good question.  
 
There are no hard and fast rules when it comes to diameter of breast implant versus diameter of breast (band width). In other words, these measurements are useful but are only one of the many factors come into play when it comes to selection of appropriate breast implant size/profile.  There is definitely some leeway when it comes to measurements and breast implant options (breast surgery is an art as well as a science).Every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery. The use of a larger breast implant (than what is safely "allowed" by the patient's anatomy) can be problematic;  potential problems include breast implant displacement/malpostion issues ( such as bottoming out, lateral displacement, symmastia...)  and/or significant breast implant rippling/palpability.
Other factors involved include surgeon dependent factors: for example, careful breast implant pocket dissection and careful selection of breast implant size/profile.
Ultimately, careful selection of plastic surgeon and  careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
 
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.   I prefer to have a wide selection of implants (all profiles) available in the operating room. 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.
I hope this (and the attached link/video, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.