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

Question

If I have one breast that’s is 10cm and the other is 11cm, what number should I abide by when choosing an implant size according to the BWD. Would an implant that has a BWD of 12 be too much since one of my breasts is 10cm?

Finny George, MD · Answer

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.

William Andrade, MD · Answer

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.

William Lao, MD · Answer

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.

Ted Eisenberg, DO, FACOS, FAACS · Answer

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

Daniel Barrett, MD · Answer

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

John L. Burns Jr., MD · Answer

All breasts by definition have some slight differences as no two breasts are ever identical.  You might try using an implant with a 10.5cm BD so that both breasts have the same implant:  volume, BW, and projection.  This would likely give the best symmetry

Ronald J. Edelson, MD · Answer

BWM is a faulty way to choose an implant size.  Somebody came up with this idea several years ago. Most surgeons don’t use it and rely on experience to select implant size

Justin Booth, MD · Answer

Thank you for your question! BWD can be a somewhat crude measurement, and there are certainly other factors to consider when deciding with BWD to go with when there is asymmetry. Nipple-midline distance in particular. generally I try to keep implant base width no greater than 1 cm more than the BWD but that is not a hard rule even for me.
Of course, it is difficult to give recommendations without photos or the opportunity to examine you. I would recommend consulting with a board-certified plastic surgeon in your area and discussing your concerns/goals with him/her.
Hope this helps! Best of luck!
Justin Booth MD FACSAustin Plastic Surgery Institute Austin, TX

Camille Cash, MD · Answer

This is where your experienced board certified plastic surgeon comes in!  After an examination and discussion of your goals your surgeon can help you select the right implant for you. One question to consider is if you have natural asymmetry that you'd like to correct (most of us have some, but it may not be significant enough to address).  In this case you may be better to select differently sized implants which would be different diameters.  I've included a video that I hope you find helpful.

James Knoetgen, III, MD · Answer

BWD, or Base Width Diameter, is an important measurement when considering breast implant size. It represents the width of the base of your breast, which is essentially the distance between the two breasts at the chest wall.When choosing a breast implant size based on BWD, it's generally recommended to select an implant with a diameter that closely matches your natural breast base width. This helps ensure that the implant will fit well within the natural contours of your chest and provide a more natural-looking result.Your plastic surgeon will consider your individual anatomy, including BWD, along with other factors such as your body shape, chest wall shape, and overall aesthetic goals when recommending implant sizes. Keep in mind that the volume of the implant is also a crucial factor, not just the diameter.During the consultation with your plastic surgeon, discuss your desired outcome and ask for their recommendations based on your specific measurements and anatomy. They will guide you to choose an implant size that complements your body proportions and meets your expectations.Remember that personal preferences, lifestyle, and individual anatomy vary, so the final decision should be made collaboratively with your plastic surgeon to ensure the best possible outcome for you.

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

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