What number should I abide by when choosing an implant size according to the BWD?

Hi, thank you for sharing your question. Generally speaking, the more you push the boundaries of the body and its soft tissues, the more chances there may be for an undesirable outcome. Factors such as soft tissue compliance, thickness and pocket placement will determine if this is a good choice or not. Discuss with your surgeon in detail.

Thank you for your question. There is no universally accepted implant sizing protocol used by all surgeons, so your recommended maximal implant width will vary depending which surgeons you see for advice. In my own experience I am reluctant to insert implants wider than a person's BWD because of concern about possible complications (visible ripples on the sides of the breasts, web/synmastia between the breasts, etc). However, if a person has asymmetry, very wide gap between the breasts, etc, sometimes it is necessary to compromise and insert wider implants while acknowledging the risks. Selecting implants is based on much more than just a person's BWD, and this measurement is not precise in any case, because the breasts don't have well-defined borders. The surgeon also needs to take into account breast shape, tissue thickness, skin tone, sagging (ptosis), and of course the patient's desired outcome.

The standard answer for a natural looking breast augmentation would be to choose an implant within your base diameter. But that doesn't mean if you choose one that is slightly over will look bad, the doctor will have to evaluate your body in person and see how wide your BWD and your chest wall and also what is the desired look you want to advise the best implant. Implants also come with different profiles with different diameters.

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Dear amandaaa123,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery