There are many factors that determine the "best" size, shape, and type of implant for a given individual. It would be extremely difficult for a patient to learn enough from reading on the internet to be able to make this decision alone. I always recommend working with your surgeon and using additional aids to come to a joint decision on the implant to be used. I personally also suggest that patients allow flexibility such that if the appearance is not exactly as expected when the implant is placed during surgery, that the surgeon is allowed to change to a more appropriate implant at that time.
It's a good question, and the fact is that choosing implant is more complicated than simply picking a size. However, the goal look that a woman desires is the starting place for implant selection. Every piece of information regarding the goal look ("natural" vs "augmented") and a woman's breast measurements helps narrow down the implant options to achieve that goal. Careful communication between the plastic surgeon and the woman help select the final implant size. It's the communication between you and your surgeon that is the most important factor to being thrilled with your breasts after surgery.
Proper breast implant choice cannot be done by patients from photos as seems so often to be the case on RS questions. You can't just see a photo you like, see the implants used, and say that you want the same thing. Nor can it be done with a nurse or cosmetic advisor in a plastic surgeon's office. You also can just plop implants in a garment in a room at the office and decide for yourself what you want. The absolute only way to get the right size is to clearly dicuss the "look" you want with your chosen surgeon. They will translate that look into the style of implant designed to make that look in most patients, then will select the right size after carefully examining and measuring you.
There are obviously different approaches so here is a list of factors to consider:
- The implant dimensions have to match the diameter of the breast. The desired implant volume therefore determines the profile because the diameter should not be changed.
- If the surgeon picks the size based on photos and discussion only, then you may not be happy with his or her choice.
- Trying on implant samples in a bra helps the patient visualize the result but there has to be a "fudge factor" adjustment because it tends to over-predict the result.
- 3-D imaging with VECTRA is also helpful but not perfect.
For all of those reasons, I think it is important for the patient to be involved in the decision making process within the limitations of their anatomy. The surgeon's job is to explain what is realistic.
Thank you for your question and photograph and congratulations on your recent breast augmentation. Each woman desires a different goal outcome after surgery and through the use of pictures and verbal discussion an image of what will work best with a patient to approximate their desires is formed by the surgeon. This includes the use of starting breast measurements of the patient as well as the use of sizers and computer generated renderings in the office. Once all information is known and considered, implant selection is then selected with input from the patient. Hope this helps.
How to Pick the Right Size and Shape of Breast Implants
One of the more frequent questions I'm asked as an aesthetic plastic surgeon for patients considering breast implants is "how do I know what size, and shape I need?” The answer to this question has changed dramatically throughout the 25 years that I've been doing breast augmentation. I've also learned that the words that patients used to describe either what they want or don't want can be completely misleading into what I interpret their meaning to be. Therefore, I like to request that our patients considering breast augmentation bring in photos of both what they think they like and what they don't like. There seems to be a multitude of sources on the Internet where these photos can be downloaded. By looking at the patient's desires, I get a better understanding of what they want. We no longer recommend that we place the exact implant on top of the existing breasts and then place a stretchy bra over it to give us any idea what that exact same implant under the muscle would produce in size. That method, in my opinion, will always over represent what the actual result will be. If you are going to use a sizing type method, then Mentor makes a shell sizing system such that, when the shell size corresponding to the implant that it represents is placed over the existing breast and in a bra, it will better represent what that size implant under the breast and muscle will look like. We've also used 3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this method, a three-dimensional photograph of the actual patient is taken and can be seen on a large screen television by both the physician and perspective breast augmentation patient at the same time. We then can place all of the different implants that are available under that image and decide what size, shape, fill ratio, and height to base width relationships will look best for each patient. Silicone gel breast implants come basically into shapes either round or shaped. They also come with either a textured or smooth surface. In my mind, there are advantages and disadvantages of every scenario and combination of those choices. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. It's then very simple to just look at size and ratio projection to base width and select the perfect implant for that patients shape and desire. Sometimes we would like to use a textured surface implant. Here the advantages are that the textured surface implants tend to migrate less in the pocket, as there is some frictional resistance to motion. Another advantage of textured implants is that the capsular contracture rate, especially when implants put above the muscle, is less than for smooth wall implants. Shaped implants, because we do not want them to turn in the pocket, are always textured. My planning method to optimize the best implant for each patient is begun with a measurement of the base width of the breast. We would then like to subtract about a centimeter and a half total off of that number so as to have coverage of breast tissue over the implant. We then will have a range of implants whose base width matches that number. If we go larger than that number, which sometimes patients will want, we as plastic surgeons know that these larger implants can have more problems down the line. For instance, larger implants may migrate below the crease which one has to lower at the time of surgery in order to get the implant in. When these implants migrate below the natural crease, they can create a second crease in what we call a "double bubble". Large implants can also; because of the pressure they put on the overlying breast tissue, thin that tissue out such that there is less overlying breast tissue over the implant as time passes. After we have the base width, our next decision needs to be what is the ratio of the base width to the projection of the implant. Essentially, there are usually four choices ranging from fairly flat which is called low-profile, to progressively more height and less width with the same volume of silicone gel, which is called ultrahigh profile. There are two profiles in between which are the ones more commonly used and these are called moderate profile and moderate profile plus. Common scenarios in which taller implants would be desired may be in patients who want a larger look than their natural base with would allow or have a fair amount of loose overlying skin that were trying to hold up. For patients who want a more natural look, a moderate profile or moderate profile plus shape is more desirable. There are also anatomically shaped implants. Rather than being around these implants can either be taller than they are wide or wider than they are tall. There are good reasons in patients to use either. For instance, in the patient's with very widely spaced breasts and a large breastbone, a shaped implant that's wider than it is tall can help hide that a little bit. Another example of the patient in who a shaped implant would be best, is that patient with laxity after childbirth or weight loss. When the nipple is just at the level of the inframammary crease, we can sometimes get away with a tall implant that is anatomically shaped such that the nipple when is it at the lower two thirds of the breast mound created by the implant still looks good and natural and may obviate the need for a breast lift. By spending some time, long before the operation takes place, using the Vectra® 3-D imaging method, we can decide what type, shape, and ratio of width to height would best serve the patient's needs. We can then avoid what is sometimes done which is the placement of sizers at the time of surgery. These sizers, in my opinion, have a few negative implications. One is that there is a cost inherent in using them and usually multiple ones are needed to make a decision as to which implant would look best. I also believe that placing sizers in and out of the breast pocket can be traumatic to that pocket and can cause bleeding. For me, the state-of-the-art in today's breast augmentation is to decide long before the operation exactly which implant would look best using computer animation. A new wrinkle into the choice of breast implants is that breast implants now come with silicone gel that is filled to a higher volume in the shell where it is placed. This will allow for a round smooth implant, for instance to collapse less in the upright position mimicking more of the look of the shaped implant. When patients show me a photo of a very rounded upper part her breast, I would likely choose one of these higher volumes implants such as the Natrelle Inspira® silicone gel breast implant. Often times patients will present with breasts that are of different sizes. One of the options to correct this is to use breast implants of different sizes in order to best create symmetry. One of the newer methods to help in symmetry creation is to do what we call a hybrid breast augmentation. In the hybrid breast augmentation, the patient who has asymmetry of the breast to begin can have matching silicone gel implants placed and the overlying breast tissue can be made to look the same in volume and shape by using fat grafting. In that way, no matter what the change in weight of the patient is over time, the breast is more likely to have the same or similar size. When it comes to symmetry, I like to tell our patients that they should consider their breasts to be sisters that live across the railroad tracks from each other rather than twins. With proper preoperative planning and flawless execution of breast augmentation, this can be one of the most satisfying aesthetic plastic surgery outcomes for both patients and physicians.