Breast Implant Sizing: How Do Patients Choose?

Dr. Jonov Explains the Implant Sizing Process

One of the primary concerns of breast augmentation patients is how to choose the right size of implants. They want to achieve their desired size and shape, but they are unsure of how to get there.

Concerns

• Will they end up smaller than they wanted to be
• Will they look too obviously implanted?

Some plastic surgeons simply choose implants for their patients. I see enough patients coming to me after having surgery elsewhere and complaining that they are much larger than they wanted to be that I do not think this is a good approach. Different patients have different goals, and not every patient wants a Dallas, Texas breast augmentation just because the surgeon likes that look. I believe that patients need to choose their breast implant size but with assistance and advice based upon their anatomy, skin tightness, etc.  That is why we have our patients try on different implant sizers at the pre-operative session approximately 2-3 weeks prior to surgery.

Are Breast Implant Sizers Helpful?

Many plastic surgeons do not believe that trying on implant sizers is helpful, and they simply choose what they consider to be an appropriate size for that patient. Of course, that may only work well if the surgeon truly understands the patient’s goals. Will the sizer placed on top of the breast in a stretch bra look identical to the same-sized implant under her tissues?  Not exactly, but close enough that it tells us how much volume the patient feels comfortable adding to their current breast volume in order to achieve a breast mound of a desired size. (Implants and sizers come in cc’s or milliliters of volume and not cup sizes, since adding a 300cc implant to an A cup breast will give a very different result than adding it to a C cup breast.) We now have an even fancier breast implant sizing method: the sizers are tapered at the edges so they fit around the breast more naturally and give a better picture of the resulting breast mound size and projection.  Also, the system’s set of small, incremental sizers allows a patient who had a previous augmentation but wants a larger size to see what 50cc or 75cc or 125cc more volume would look like.  I feel that this has improved the accuracy of the pre-operative sizing technique.

The Role of Skin Elasticity

Is choosing an implant volume the end of the story? No, because every patient’s skin quality and elasticity differs greatly.  If a patient’s skin is loose and the breast “deflated”, perhaps after pregnancy and nursing or after weight loss, then a much larger range of implant sizes can be used and still give a natural look. If a patient has tight skin, there is a much greater limit on how large an implant can be used without it being too tight and the result very unnatural.  That is why I show patient’s pictures of different breast contours that differ in the amount of upper pole fullness (since that is where a too-tight implant will show bulging and an obvious implanted look), and I ask the patient to tell me which contour they prefer.

Bring Photos to Your Consultation

I also encourage patients to bring in a few photos of breasts that they like.  Can we necessarily match a photo? Of course not, every patient’s tissues are different. But this process helps to communicate what the patient’s goals are so that I can try to meet them. Using all of this information, I will go into surgery knowing what the patient’s ideal choice of implant size will be IF it achieves the contour or look that she is striving for.  I will use sterile sizers at surgery to make sure that the chosen size of implant will fit and be consistent with her desired contour. If her tissues are too tight and the upper pole of the breast too “bulgy” and unnatural in appearance, the patient will have told me in advance whether they give me permission to try smaller sizes until we achieve her desired appearance. Many surgeons do not use sterile sizers in the operating room, but we keep every size in all three profiles sterile and available to use so that the appearance of the permanent implant can be accurately predicted before we commit to it.

Choosing Breast Implant Profile

Which profile of implant (moderate, moderate plus, or high) is chosen based on the width of the implant and the width of the patient’s breast and chest wall. Choosing too wide or too narrow of an implant for a given patient’s breast dimensions will compromise their result, so careful measurements prior to surgery will lead us to choose the proper width of implant for a given volume that will be the best choice for that patient. – Dr. Craig Jonov, Seattle Plastic Surgery