Should Surgeons Choose Breast Implant Size?

I am scheduled to have breast augmentation in a few weeks. My PS says he will not choose a breast implant size for me and recommends I do the rice test and/or try on sizers in the office.

But most forums say that these are unreliable measures for sizing. How do you other doctors feel about his decision to not choose the size? Should this be a red flag?

Doctor Answers 24

Combined Effort of Surgeon and Patient in Final Implant Choice

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I do think your surgeon has a key role in guiding you to the optimal implant choice.   Three factors play into my decision.

1.  patient history and desired end result

2.  chest wall dimensions and breast measurements

3.  in office implant sizing based on patient history (desired end result) and chest wall measruements


I believe the in office sizing with similar profile implant sizers is critical to a happy patient. I think the time spent in this decision process is very well spent.   Many times a patient comes to a realistic conclusion of what result they can expect.   It also helps patients identify what results are realistic and safe.   If this does not meet their goals and desires, it helps prevent an unnecessary surgery that will result in an unhappy patient.


I hope this helps and i wish you a safe and happy recovery.



Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Should Surgeons Choose Breast Implant Size?

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Should Surgeons Choose Breast Implant Size? No a surgeon should guide and may suggest implant size and type and placement in the process of educating the patient.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Newer techniques for choosing a breast implant size

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This is a decision that the patient makes, with the advice of the surgeon.  It is important that the surgeon and patient agree on the size to be used, and various methods help to arrive at that decision. 

The old methods of using a bag of rice, or trying on implants in a bra do help to some degree, albeit with some limitations.   It helps me when a patient brings in photos of other patients from the Internet or from magazines to tell me what she wants or doesn't want.  Certainly her comments regarding my own patients' photos help me understand what she is looking for.

Allergan has a program where a prospective patient can get a special bra from their company with pockets and simulated implants to try at home.  At my office, I have the Axis Three 3-D morphing system which has been a great help to my patients to give them a much better idea of what they will look like after a certain size is placed.  In addition to measurements that I make, the computer system will also calculate their measurements including volume and help quantitate any asymmetry, which I can then correct for at surgery.

Choosing an Implant

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Hi there-

There are various reasons why a surgeon may not want to be responsible for the decision...:

1. After surgery, if you express dissatisfaction, they can wash their hands of the situation because you chose the implants.

2. It simplifies the consultation process for them, because once you have made the decision to have surgery, they can have you choose the implant with their nurse, or even at home.

3. It is a lot less expensive and easier for a surgeon to only have to order and pay for implants as they are used.

This decision making process seems preferred when the surgeon's goal is to complete the surgery and have as few problems with patient expectations as possible.

Here are the reasons I personally think your surgeon MUST be very involved in the decision making in order for you to achieve long term satisfaction:

  • The appropriate choice of implant involves understanding NOT just your desired goal for size, but also your anatomy.
  • Variables such as:
  1. your body's dimensions
  2. skin quality and the quantity of skin present
  3. the amount of breast tissue present and its qualities
  4. the details of your reproductive history
  • will all affect the way the implant interacts with your tissues and will therefore affect your outcome and satisfaction.
  • These are subtleties that it is not fair to expect a patient to understand. 

My goal as a surgeon is to have happy patients (not to simply complete the surgery).

Because I feel strongly that patients who are happy will not care what number is on their implants, or what letter is on their bra, I do not use the patient choosing the implant approach.

The key with any decision making process is effective and open communication.

If you're not comfortable with the process, put on the brakes. Talk with your surgeon- you need to be confident before the surgery that your chances of achieving your goals are maximized.

Doctor and patient should choose breast implant size

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In my practice, choice of breast implant size is a joint discussion and decision between me and my patients. Height, shoulder and hip width and body proportion are some of the elements that should be taken into account and discussed in-depth when choosing a breast implant size. I try to help my patients in choosing an implant that will enhance their overall body shape by taking all of the above measurements into account. I believe that a mutual, honest dialogue and decision is very important in order for the patient to receive the best results.

Deason Dunagan, MD
Huntsville Plastic Surgeon

Always a combined decision

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By performing a series of measurements the surgeon can help determine the range of sizes that could be used in a particular patient. This is followed by an informed decision by both the surgeon and the patient as to which exact size to pick from that range.

Sizers and other patients before and after photographs can be helpful for the patient to communicate to their surgeon which shape and volume they like best.

It is never a patient only decision.

Who Should Choose Breast Implant Size?

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Coice of implant size is not the responsibility of the patient or the surgeon but both.  First the surgeon must point out the anatomical features of the patient including current breast size, shoulder width, hip width, waist and buttock.  Other things to be considered include: personality, profession, athletics and age.

Once these things are discussed then I have patients try on sizers with a tight sports bra and a top.  This will give a good idea of the volume but not necessarily the elevation.

Finally the surgeon must use his experience and expertise to guide the patient.  I provide patients with all of this information in text and video form on my website so patients can be more informed consumers.

How to choose a breast implant

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I agree there is a lot of confusion about how to choose a breast implant for breast augmentation and I agree with your sense that external sizers are unreliable (as are comparing to photos) and that maybe this is a red flag for your plastic surgeon's experience. If you went to an orthopedic surgeon for a hip implant you wouldn't care to choose the implant yourself. Nor would you feel comfortable in a cosmetic procedure like breast augmentation with the surgeon deciding it during surgery and telling you what he or she chose for you afterwards.

The process is not as rigid as deciding a hip implant and is more like fitting a dress or fitting your foot in a shoe. You don't tell the sales clerk what size dress you like or what shoe size you like. You figure out what style and size fits you together. If you don't know what size you are then you get measured. The problem with breast implants is that there is no good way to measure your breast overall size or to "try on" the implant and see if it fits you.

Experience of plastic surgeons on this has moved away from size as simply the volume or how many cc's the implant contains to measuring the dimensions of the breast and knowing what the dimensions of the implant choices are and what effect they will have. The width of the implant (and the height if it's round) are going to need to be matched to the measured external width of your breast if the implant is going to fit behind it and look right.

The patient chooses whether they want a saline or silicone gel filled implant and how much forward volume (profile) the implant will have that will increase their existing breast size by a cup size (low profile), a cup and a half (medium profile), or two cup sizes (high profile). The terminology varies for the implants, there is at least one other option between medium and high profile in saline and not all the implant manufacturers have all profiles available and properly scaled for the width (diameter). There are also exceptions if the breast is unusually wide or narrow, but in general your breast width determines how wide the implant will be and you choose the type and forward projection. The volume in cc's is looked up in the matrix of available implants.

Scott L. Replogle, MD
Boulder Plastic Surgeon

Choosing a breast implant

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Choosing the correct impalnt for you is a decision that should be made with your doctor.  Based upon the physical exam and the patient's request, I come up with a plan and a recommended implant size. I like my patients then to go home and do the "rice test or water test" with a baggy to see if that is the size that they want or  do they want to be slightly alrger or smaller. Usually we "hit it on the head"  from this, and the patient is happy after surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Choosing your Breast Implant Size

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I consider two factors when selecting implants for my patients: 1.Dimensional planning
2.Gel Implant Sizing system Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. Even your fitness levels and other relevant criteria are taken into consideration. It is you who will decide what you are comfortable with. Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.

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.