Breast Implants - Choosing the Right Size

Breast Implants - Choosing the Right Size

Breast augmentation is the most popular procedure in our practice - we help several hundred women with this each year. In order to have a happy patient, one of the most important choices we make together is figuring out exactly the right size for the implant. The three of us - the patient, my nurse and I work together on this, until we've found "just the right one".

Most of my patients request something that looks "proportional" for their frame. Most of them want something in the mid-C to small-D cup size.

In the old days, implants were chosen by volume - if you wanted to be 2 cup sizes bigger, you needed a 300-400 cc implant. Unfortunately, that calculation didn't take into account the patient's height, size of their ribcage, or other parameters that vary widely from one person to another.

I think the key factor is to get the implant width right. After all, most women who are signing up for breast surgery want a nice cleavage - and want to avoid a big gap in the center. Most augmentation patients also want to fill up the width of the breast nicely, but avoid looking excessively broad in the chest, with the implant being so wide that it ends up sticking way out the sides, under their armpits.

While other doctors may have different opinions, here's a quick summary of what I do:

1) Start by measuring the width of each breast with a tape measure - going straight across from the area of the cleavage, to the outside of the breast. This will give you a number which varies from 11-12 cm in a petite patient, to 15-16 cm in someone with broad shoulders.

2) Next, subtract a little depending on the amount of breast tissue the patient already has. I estimate this by measuring the "pinch thickness" of the breast laterally.

3) Now that we've determined the approximate "base width" - the footprint - of the implant, we can have the patient try on implants of this particular width in a sports bra and T-shirt, and see what she likes in the mirror. We know that these implants are going to be the right width for the patient's frame.

Of course, the look of the implant in the sports bra isn't identical to what we're going to see post-operatively, but it is a good approximation of the size and weight, and it's probably more accurate than computer imaging is at the present time. If anything, the implant in the sports bra looks a little bigger than it will once the surgery is done.

This try-on process takes a good bit of time with the patient, so that's the reason that many other surgeons don't do it - but it really makes a huge difference in the quality of the results and in overall patient satisfaction.

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