What role does BWD play in breast aug?

Question

I am just curious how bed will affect a breast aug… my bed is 12.5cm and I am deciding between Sientra 355 M+ (12.1cm) and 385 M+ (12.5cm). I am doing subfacial.. is it better to have an implant a little less than my bwd for a more natural look? Or is it best to match the width exactly if you can? I don’t want rippling. Will it make much of a difference? Another option is 385 HP (12.3cm), but worried about the more fake look of HP.

Joe Gryskiewicz, MD, FACS · Answer

Hello,
Breast width diameter plays a important role among other measurements to ensure the implant profile and size will fit you best. High profile typically means you will gain more projections. Everyone has their own version of what fake looks like tot hem. My best advice is to try the implants on in the office if able.
All the best,
Dr. Joe

William Andrade, MD · Answer

Thanks for your question.  Breast width is an important consideration when choosing implants.  If you choose implants that are much wider than your breasts they could cause problems like synmastia (lack of a gap between the breasts) or visible rippling in the cleavage and "side boob" areas.  On the other hand, choosing implants that are much narrower than your breast width can also look odd.  For example, if a patient with wide breasts chooses high-projecting implants with a narrow base, they can look like prominent lumps rather than naturally filling in each breast.  Although there is no universally-accepted implant sizing method used by every surgeon, in my practice I usually recommend implants that are a little smaller than the person's BWD.  This ensures that there is breast tissue covering the implants, yet they still fill out the existing breast shape.  However, there are exceptions to every rule.  For example, some women have very small, widely-spaced breasts (such as tuberous breasts).  In this case it may be better to accept the risk of inserting implants that are wider than the breasts, to help create a more proportionate appearance.  Implant selection is a balance between choosing implants that are large/wide/full enough to meet the patient's goals, while considering the risks/disadvantages of inserting implants that may not have sufficient tissue coverage.

Daniel Barrett, MD · Answer

Dear Fabulous50618,
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

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to breast surgery and revision breast surgery. Many surgeons and patients put way too much emphasis on breast width dimensions.  After being in practice for almost 30 years, I feel that it is the least important measurement as well as the least useful measurement. There is way too much emphasis on this measurement. The most important piece of information from your short Intro is that you are placing an implant in the subfascial location. Basically, subfascial equals subglandular.  The fascia of the pectoralis major muscle is less than a half of a millimeter and provides minimal strength.  I would caution you from doing this.  I have a whole gallery of poor outcomes from long-term changes associated with implants on top of the muscle. Best wishes to you.

Ronald J. Edelson, MD · Answer

Breast width became a gimmick about twenty years ago to determine implant size dejection.  However it is faulty and often ends up recommending implants that are too small.  I don’t use the method.  You are best off forgetting it

Finny George, MD · Answer

Hi, thank you for sharing your question. The more you push the natural parameters of the breast, the more fake the implants will seem and the more inclined you may be to develop soft tissue complications. It is generally ideal to stay close to the base diameter. The implants you selected won’t significantly “push the envelope”.

Connie Hiers, MD, FACS · Answer

Your surgeon is the best one to guide you in this decision. However, don't exceed the width of your base or the implant may be more noticeable.  The smaller implant may give the best natural look.  Photos would be helpful.

Camille Cash, MD · Answer

BWD is a tool used to help with implant selection.  It helps you and your surgeon find a range of implants that may fit well in the breast pocket.  Many surgeons have sample implants that you can "try on" to help you get an idea of how you may look after surgery.  Another tool I use is sizers.  This helps me to select the implant that fits best with my patient's goals and the anatomy for the best result.  I've included a video that I hope you find helpful.

Justin Booth, MD · Answer

Think of your breast width as your shoe size. If you wear a 9, you can probably get away with wearing an 8.5-9.5 but not a 7 or 11. The BWD is the height/width of a round implant. It is important to match the BWD with your base width. There is a cm to work with on either side depending on what your goals are.
Having said that, the differences between the implants you mentioned are minuscule. The numbers sound like larger increments than they are clinically. 2mm is not going to make a tremendous difference one way or another. 
For a given BWD, the fuller or higher profile implant will give you more projection by a few millimeters.
Hope this helps!

Mats Hagstrom, MD (license on probation) · Answer

Each plastic surgeon will have their own preference for how to determine an ideal Breast implants.
There isn’t a right or wrong yes or no answer to your question.
From a patient’s perspective, I suggest focusing your efforts on finding the best provider.
The pectoralis muscle does not have fascia, except for in the origin and insertion.
There is no sub facial plane for breast implants.
If you look at anatomy books, you’ll see, there is no fascia over the central pectoralis muscle.
Best,
Mats Hagstrom, MD

What role does BWD play in breast aug?

Answers (10)

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