Implant size is best determined in conjunction with your provider. Each plastic surgeon will have their own way of guiding patients through implants selection process. From your picture, you breast have pretty good diameter so you could conceivably work with fairly large implants without having excessive risk of problems. That said Whenever patients or surgeons choose excessively large implants the chance of undesirable, side effects, complications, and the need for revision surgery will always go up. This is especially true if the implant is simply much bigger than the natural diameter of the breast. It’s always safer to stay on the more modest sidebut this needs to be balanced against patient coming back for secondary revision surgery, increasing implant size that may have been unnecessary if the implant size was well-made the first time. The chance of complications and needing revision will always be lower when working with more modest size implants. Once the tissues are stretched out, it becomes more complicated to go down in size later. My personal preference is generally to use more modest size implants, but patients often want bigger implants than what I would personally choose. I typically respect the desire of my patience, but also inform them of the risks with using excessively large implants, especially long-term. Each plastic surgeon will have their own way of determining the final implant selection. My preferred method is to work with before, and after pictures of previous patients who had very similar body characteristics. I typically ask my patients to bring in a number of before, and after pictures they consider ideal. I ask my patients to select examples of previous patients who have very similar body characteristics to their own. Once I have a clear understanding of what the patient is hoping to achieve, I bring those pictures with me to the operating room. During surgery I use temporary sizers. I typically have a full selection of implants at my disposal during surgery and select implants based on which sizer gave me results. Consistent with my patient wishes. I found this to be the most accurate way of implant selection. Some providers ask patients to make the final decision, and only bring one pair of implants to the operating room. Some providers guide patients through the implant selection process better than others. Each provider will have their own way of doing this. Generally speaking, I always encourage people to have multiple in person consultation before selecting a provider. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own. An experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, only representing the best results of a provider career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures they’ve actually done. Ask each provider what their most common indication for revision surgery is, what their revision rate is, and what their revision policy is. All plastic surgeons, including the very best due revision surgery. Claiming to have a zero revision rate is hardly ideal. It generally means providers are not willing to go the extra mile to get the best outcome for their patients. be careful with providers who need to correct implants that have bottomed out from their first procedure. This undesirable side effect represents anatomically poorly placed implants, and should not happen in the hands of sufficiently experienced providers. There’s no correct number of consultations needed to find the right provider. The more consultations you have the more likely you are to find the best provider for your needs. The biggest mistake patients make is having only one consultation which more or less eliminates the ability to choose the better provider. Breast augmentation outcomes are generally based on three different variables. The first variable is the patient’s candidacy for the procedure. Individuals who have breast a symmetry, breast that sit wide on the chest wall or have nipple divergence, may not get the same quality outcome as those who do not. There are a number of variables that change someone’s candidacy for this procedure. Nipple divergence will be amplified with the placement of large implants, especially high profile implants. (Your right breast?) The second variable is implant selection in regards to size, shape, and type. The third variable is the surgeon ability to place the implant in the correct anatomic location. My personal preference is sub, pectoral placement, leaving as much of the implant covered by the pectoralis muscle as possible. Best, Mats Hagstrom, MD