What to do when you get sized differently by two different surgeons?

Hi everyone. I had my first breast augmentation consultation last week for an a to c enhancement. After measurements, I was told I am sitting at a 13 cm width for my breasts and I was told a 339 cc mod+ round smooth silicone would look amazing on me. I almost booked but decided to go to my second consultation. This doctor measured me at 11cm and told me that 240cc is the max that he would put in because I'm so small. Who to believe? The recommendations are so different! I'm 5'5 and 115 pounds.

Doctor Answers 10

What to do when you get sized differently by two different surgeons?

It is important that an implant is chosen that will fit properly and safely into the width of your breast...but if the breast is narrow and needs to be expanded, as in a narrow-based constricted breast with a wide space between the breasts, then the measurement must take into account the "desired" new breast width. You have apparently seen two surgeons who have measured your breast differently, so perhaps you should have another consult (or discuss this with those two surgeons) and see why there is a discrepancy. We have patients try sizers on and determine what volume implant they would like to add to their current breast volume. We measure their breast width and determine whether a moderate profile or a high profile (ie: narrower and more projecting) implant of that size would best fit their breast and chest width. We have the patient show us through photos how much upper pole fullness they desire (that is, how natural vs. augmented a look they want), since with tighter skin and tissues this can limit the size of implant. If a large implant is chosen, and even a high profile implant of that size would be too wide, then we tell the patient that their breast is too narrow for that size of implant. For what it is worth, you would have to have a fairly narrow breast to be limited to a 240cc size implant...it is not that common that we have to limit the implant size that much based on breast width, though if the skin is tight and the patient wants a very natural look, sometimes that can limit the size to that degree.

Different Size Recommendations, What to Do?

Good photographs might be helpful in answering your question, but an in person consultation would be needed for any specific advice. Here are some things to consider when trying to choose an appropriate size implant. 

Cup sizes are unreliable, and vary from bra to bra, so it is best not to get too focused on a specific cup size. The Base Width measurement is very important but also somewhat subjective and therefore can vary from surgeon to surgeon. Still, in your case, those are widely different numbers. Your height and weight measurements suggest that you are thin and have a small frame, so that 13 cm number sounds overly wide to me. The problem with putting in an overly wide implant is that it will give you excessive fullness to the outside with thinning of your tissues. Over time this can lead to a palpable or visible implant and possibly visible rippling, even with a gel implant. On the other hand, an overly narrow implant can leave you with an excessively wide space between your breasts which is also unattractive. 

It sounds like the second surgeon is being conservative because of your small frame while the first surgeon may belong to the bigger is always better camp (not!). You were right to not have booked after just the first consult. Unfortunately you managed to find another surgeon who seems to be taking exactly the opposite approach. Your best option would really be to go for another consult and explain to the surgeon what has transpired so far. Before you go, think very carefully about what you want to look like post augmentation. Consider finding some "wish" pictures to bring along to your consult. I find that implant "try-ons" are also very helpful in choosing the overall implant volume, and then different implant profiles can be considered according to your base width measurement. Do not choose your surgeon based on cost. Low end providers tend not to take the time needed for careful  consideration of your specific circumstances that will have very big impact on your long term outcome. 

What to do when you get sized differently by two different surgeons?

Those two opinions are quite different. I would recommend a third consultation with another board-certified plastic surgeon.Your goals, breast measurements, and the characteristics of your tissues are the key to sizing a breast implant. It's important that your surgeon explain the decision-making process of choosing an implant, so that you both can move forward with confidence that you have selected the right implant.

Find the right size for you

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants

Best Way to Get sized

There are 4 questions that must be answered in a BA Consult.1) Type of implant - Saline, Silicone, and Form Stable2) Location of incision - Axillary, Periareolar, Inframammary3) Above or below the muscle4) Size. - most important.  It is the result of how much tissue you have and how large an implant you choose.  Everyone has a different thought about what a "C" is.  I use a bra with implants in them.  Try different sizes in front of a mirror until you like the look.  Then we can see whether that implant can be used based on your measurements. Both implants in your case sound reasonable.

Richard Greco, MD
Savannah Plastic Surgeon
4.9 out of 5 stars 19 reviews

What to do when you get sized differently by two different surgeons?

You might have to go to each surgeon and ask for an explanation  and to draw on your chest what they are measuring. Here's what I think might have happened. The first doctor may have measured the existing breast to enlarge it. If so he's a just a technician who makes a cut and puts in an implant. The other surgeon probably measured the space he wants to enlarge to create a new shape that will better fit your chest. If so he's an artist actually interested in creating beauty for you. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

I appreciate your question. 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.   Silicone will give you a 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 more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion. Anatomic gummy bear implants might be a good choice to give you volume. These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are 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. 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 Director-Beverly Hills Breast and Body Institute #RealSelf100Surgeon #RealSelfCORESurgeon

Measuring breast width in breast augmentation is critical

This is a critical measurement because it determines the correct width/diameter of the implants that will fit you well. If the measurement is incorrect and is too narrow, there will be a gap in the middle called Death Valley. If it is too wide, you risk a unibreast or "side-boob." I'd suggest that you seek another consultation from a surgeon whose photos show what looks to you to be the optimal space between their implants (cleavage) and assume they get this right. Go to them and see what they measure you at.

What to do when you get sized differently by two different surgeons?

It is extremely common to receive different opinions from different plastic surgeons about the best way to treat a specific “problem”. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices. It is quite amazing how adamant each plastic surgeon can be about the superiority of his/her recommendations…

Although these different opinions can be confusing and a source of anxiety for patients, it is good for patients to understand the different options available. Ultimately, it will be up to each patient to do their due diligence and select their plastic surgeon carefully. Part of this selection process will involve the patients becoming comfortable with the plastic surgeon's experience level and abilities to achieve their goals as safely and complication free as possible. If I were you, I would ask to see as many examples as possible of similar patients who your plastic surgeons have helped.
Ultimately, you will need to select your plastic surgeon carefully,  based (mainly) on your confidence level that he/she will be able to deliver your desired outcome.  If in doubt, seek additional opinions and/or meet with the doctors you are considering again.
 Best wishes.

Implant sizing

Thanks for your question, and I'm sorry to hear about the confusion between your two consultations. At 5'5" and 115lbs, you likely have a very fit and petite frame, so I'd be surprised if your breast base width was really 13cm. Still, even if it is really closer to 11cm, you could choose a higher profile implant to give you the volume you desire. You would likely be somewhere in the 350-375cc range if you went with a high profile implant. Perhaps one more consultation, or go back to the one you trusted the most and ask to try on the implants again in a non-padded bra. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 7 reviews

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.