Implant Diameter relative to Breast Width? (Photo)

Question

I read John Tebbett’s book Augmentation Mammaplasty and in it the High Five method of tissue-based planning. For “natural” results can you go right up to the BWD with the implant diameter? Or is it optimal to go smaller than BWD? If so, by how much? My BWD was measured at 12cm (but may be closer to 13cm) and I’m trying to decide between Mod+ Xtra implant of 11.5cm diameter (295cc) or 11.9cm diameter (325cc). I’m 36 yrs old 5’8” 165lb. No ptosis. 0 gravida. Good skin quality, no laxity.

Anna Steve, MD · Answer

There are a number of factors to consider when your goals are a natural- looking breast augmentation. Generally using smaller volume, lower profile (also known as projection) is the best way to achieve a more natural appearance. It may also be worth considering using fat transfer (also known as fat grafting) in addition to an implant to add natural volume and customizable cleavage. This helps to soften aesthetic lines and hide the borders of the implant in thin women. 
It is important to respect the base width diameter, as this is the measure of your breast 'footprint'. Not respecting this and using and implant that is either way to narrow or way to wide can distort your breast aesthetics. In general i think it acceptable to use an implant that measures up to 1 cm less than your base width diameter and up to one half of a centimetre wider and still maintain breast aesthetics.

Jose Telich, MD · Answer

The decision on the optimal implant diameter relative to breast width for a natural-looking result can vary depending on a patient's individual factors and goals. However, generally, for a natural look, it is often recommended to choose an implant diameter that is slightly smaller than the breast width.
Based on your BWD measurement of 12-13cm, the 11.5cm diameter (295cc) implant you are considering are within the range of your BWD. However, the final decision should be made in consultation with a board-certified plastic surgeon who can take into account your specific anatomy and goals.
It's important to note that implant diameter is just one factor to consider when choosing breast implants. Other factors such as implant projection, implant shape, and type of implant (saline or silicone) also play important roles in achieving a desired outcome.

Joshua Cooper, MD, FACS · Answer

- We commonly place breast implants that are the same width of our breast augmentation patients' base diameter. You can still look natural if you go up to that natural base diameter, or breast width, that you have.
- As you might expect, the more you exceed the width beyond your own base diameter, the more "side boob" you'll have after your breast augmentation. 
- You would look great with either implant size you have listed above. 
- Best of luck to you, and thanks for sharing!

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.  I might be an outlier, however I believe measuring the breast width is almost irrelevant.  I am currently writing a paper in which I use implants of a much less diameter than the breast or chest width with excellent results.  The Hi-five method will be used as a general guide.  Best wishes to you.

Ronald J. Edelson, MD · Answer

Selecting implant based on breast width is nothing more than a gimmick that many surgeons bought into. It is a faulty way to choose size and almost always gives you a size that’s too small.  You need at least 325 and you could even go a bit larger.

Ram Kalus, MD, FACS · Answer

Thank you for your question and photos. In my hands for a most natural appearing augmentation the BWD of the implant should be approximately two cm narrower than the BWD of the breast. However, measuring techniques and methods vary. In my own practice I gently press a template against the breast and wish to see at least 1 cm of breast outside the template. This may vary somewhat based on skin pinch, skin laxity, and degree of ptosis, but ultimately it is the expressed wishes of the patient (with wish photos) and the experience and aesthetic judgment of the surgeon that determines the optimal implant selection. Another important consideration is pocket creation and relative nipple areola position. In your case, your nipples are fairly laterally positioned and care must be taken to avoid accentuating that lateralizarion. Optimal breast aesthetics will have the nipple areola central on the breast mound or slightly lateral. The greater the cleavage the greater the danger of an exaggerated lateral appearing nipple/areola.

Do your research and select your plastic surgeon based on his or her aesthetics as derived from their published gallery, as well as your good judgment with regard to confidence in your plastic surgeon and the office staff. Best of luck to you.

Do your research and select your plastic surgeon based on his or her aesthetics as derived from their published gallery, as well as your good judgment with regard to confidence in your plastic surgeon and the office staff. Best of luck to you.

Daniel Barrett, MD · Answer

Dear Modest400975,
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

Connie Hiers, MD, FACS · Answer

Your surgeon who has much more knowledge and experience than you can help you select the best fitting implant for your tissue and frame. It is more involved than just selecting the base width.  You will be paying for that knowledge.

Shana Kalaria, MD · Answer

Wow! I am impressed by your research and reading in preparation for your surgery. Generally speaking, yes, you should not go too far above the BW for fear of looking top-heavy. Your frame and measurements can accomodate either implant EASILY. In my opinion the 325cc would look better than the 295cc. If you are looking to be closer to a B then opt for the 295. If you want to be closer to a C then opt for the 325. Good luck!

Camille Cash, MD · Answer

There are many factors that go into selecting the right implant for a patient.  BWD is one of them, but there are many others.  This is why it is so important to select an experienced board certified surgeon.  Your surgeon will use her/his expertise in considering your goals and combining that information with your anatomy to help you get as close to the look you want as possible.

Implant Diameter relative to Breast Width? (Photo)

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