What happens if your breast implant diameter is smaller than your BWD?

Question

My BWD is 12cm (two doctors measured me at 12 and another doctor measured me at 11.5) My surgeon has recommended I go with either 335 (11.5 Diameter) - 345 (11.75 Diameter) high profile silicone. I know the difference is minuscule but I am wondering what would happen if I went with the 11.5 diameter implant if my BWD is 12cm. Will they look weird / too tubular / not wide enough? I have very broad shoulders Thanks!

Richard Baxter, MD · Answer

The measured diameter is external, and you have to allow for some "padding" over the implant so it has to be less. Exceeding that means dissecting a pocket that extends outside of the breast where it will be more visible and less well supported.

Leland Deane, MD, FACS · Answer

So, the term base width has been used so often and it has driven many breast augmentations to be bad breast augmentations, because the implant pocket (space for the implant) has been over-dissected to make room for an implant which is too large. Also, the base width simply cannot be measured that accurately by you standing in front of a doctor, or Vectra machine. The measurement is a rough, very rough, approximation.So why does it matter and how do you use it or even find it? When the dissection is done, an experienced surgeon will be able to see the exact base width by going from one anatomic margin (lateral sternal border) to the other (lateral attachment of the breast to the serratus anterior muscle).So how is this used? It's really not that complicated. Most state of the implants will use a projection which is a little higher, so with a little more narrow base implant width per volume. We call this 'high profile' or 'moderately high profile'. Stay away from medium profile and ultra-high profile. I bring several sizes to the operating room and try and use the exact one the patient and I decided on. It may be necessary however, to use an implant which is either slightly smaller or larger, so there is no 'wrinkling' when the implant is placed.This is a little simplified but definitely not a cut and paste answer!Hope this helps.Bottom line, if you're choosing an implant based on base width, you're on the wrong track. Go with doctor experience.

William Andrade, MD · Answer

Thank you for your question.  It is not uncommon for different surgeons to have slightly varying estimates of BWD, because breasts don't have well-defined boundaries.  For this reason BWD is not an exact measurement.  If a surgeon has a focussed practice on breast augmentation, they will develop a system for sizing implants that works well in their hands and achieves good outcomes.  I agree that difference between 335 and 345cc implants is very subtle and would not be expected to make a big impact on the final result.  However, the surgeon(s) who have done an in-person assessment will be able to give you a better idea of the final look you may achieve.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Best to have the implants fit within 0.5-1cm in diameter to appropriately fill out the breast skin envelope.  Going too narrow can create a "rock in a sock" appearance.  A slightly smaller implant than BWD will afford more soft tissue coverage and a more natural result. Hope this helps.

Gerald Minniti, MD, FACS · Answer

Everybody talks about BWD like its the only measurement, but it is not, nor is it the 'most important'. What is your nipple to fold distance on stretch? If it's 6 or 7, those implants will either leave you with a low nipple position or a double bubble, depending on what the surgeon does in the operating room. If its 8 or more you'll be fine. If your surgeons didn't measure, you need to go to one who does.

Dana Goldberg, MD · Answer

Base width is important to me when I pick implants for patients, but 0.5cm is not a large difference and wouldn’t even be noticeable to most people. It’s only when the base width is off by 2-3cm that some patients develop issues with the implant filling out the entire cleavage. It depends on where the implant is placed and how much breast tissue someone has.

Ronald J. Edelson, MD · Answer

I have to admit this measuring if the body width never was if very much use to me. I use my experience and the patients desires to choose an appropriate implant. The implant sizes you mention are in line with what I usually use and makes most women a full C cup. The 10 cc difference won’t be noticeable.

Daniel Barrett, MD · Answer

Dear Adventurous4058,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Daniel A. Medalie, MD · Answer

HI,My main advice is don't sweat the small stuff. You are overthinking this. There is essentially no difference between the two implants and you should entrust your doctor to make the right choice. Good luck.Daniel A. Medalie, MD

Pejman Aflaki, MD · Answer

Hello and thank you for your question. BWD is not an absolute number and there is always some inter-observer variability between plastic surgeons. 5 mm difference between the two is not significant, and you can go either way. If in doubt between the two, I would go with the bigger one. Best,
Pejman Aflaki, M.D.                                            
  
Johns Hopkins-trained double board-certified plastic surgeon

What happens if your breast implant diameter is smaller than your BWD?

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