Patients are often surprised to find out that the relationship between implant size and final breast appearance can be complex.
Once a breast augmentation patient has shown me their ideal breast appearance by selecting their favorite patient photos on our website, I make sure that the before and after pictures they chose are relatively realistic for them. If the comparison is unrealistic for that patient, I’ll keep the “ideal” in mind and also direct them to more realistic comparison photos.
Deciding on the correct breast implant size is one of the more challenging aspects of breast augmentation. This blog post will discuss factors that affect the decision, questions to consider, and the methods I use to determine the correct implant size during surgery.
Factors That Affect Implant Selection
Each patient has unique breast features that carry over to their breast augmentation results, but seeing photos of the patient’s ideal helps me focus on their preferences regarding size, proportion, upper breast fullness, breast width, and cleavage.
These individual physical characteristics will affect the final appearance of implants:
The Patient’s Body Type
The first thing patients need to understand is that the term cc (cubic centimeter) simply refers to volume. To convert this from the metric system into ounces, 1 ounce equals approximately 30 cc. In other words, a 300-cc implant has a total volume of 300 cubic centimeters or approximately 10 ounces.
How this volume impacts a given patient depends on many factors. For example, when patients ask how many cc’s make a given cup size, I answer their question with another question: “How far can you drive on a gallon of gas?” They usually pause and say: “It depends on which car I’m driving.” One can drive much farther on one gallon of gas in a Prius than in a Hummer. Likewise, a 300-cc implant will look a lot bigger on someone who is 5’1″ and 100 pounds than on someone who is 5’10” and 175 pounds.
Breast width, ribcage shape, and asymmetry also affect the final breast appearance and factor into the decision.
Natural Breast Tissue
Another factor that determines the final result is your existing breast tissue. Some patients start with a lot more breast tissue than others. The final breast volume is made up of both the natural breast volume and the implant volume. In other words, Preexisting Breast Volume + Implant Volume = Final Breast Volume. The less biological breast tissue you have, the larger the implant you need to reach a given volume.
Skin and Tissue Elasticity
Another consideration is the elasticity of the tissues or how much the skin stretches. Patients with very tight, thick tissues will tend to compress the implant more, making it look smaller. Looser tissues—such as those of patients who’ve breastfed or lost significant weight—will stretch more, allowing the implant to look more prominent.
These variations are why 2 patients with a similar final appearance may have very different-sized implants. This is also why I feel it’s easier for a patient to choose a desired “look” than an implant size.
Additionally, these questions should be considered:
Are larger or smaller implants better?
I ask my breast augmentation patients whether they’re more concerned about being too big or too small, so I’ll know which way to lean once I’m within their target size range. Most patients prefer to lean toward the somewhat fuller side of their preference range, although others are more interested in maintaining a smaller breast size.
What is an appropriate, proportional breast size for this patient?
In addition to a patient’s desires, matching an implant appropriately to their tissue parameters is essential. In other words, the implants must fit the proper width of their breasts and not exceed the capacity of the tissues and skin to support the implants. This is where my judgment and experience as a surgeon come in, and I guide patients to a choice that will both meet their initial goals and hold up well over time.
My colleague Dr. Sigalove discusses how the width of the breasts affects sizing in this video:
How Your Plastic Surgeon Determines the Correct Implant Size During Surgery
One of the most crucial steps in breast augmentation surgery is ensuring the selected implant aligns with a patient’s desired look. This process is multifaceted and involves both technical precision and a keen aesthetic eye during surgery.
Creating the Breast Implant Pocket
In the operating room, I create appropriately sized breast pockets for the patient, taking care to maintain as natural and smooth a space for the implants as possible. I then place a sizer (a replica of the actual implant) into the first breast pocket. The size and profile sizer I initially select is based on the patient’s preoperative size and shape wishes, their tissue parameters, and my experience to give them the best overall result.
Determining the Final Implant Size
Once the sizer is in place, I examine the patient both lying down and with the operating table in the seated position (with the patient still asleep) to assess the implant’s size, position, and contour. I then try other sizers while comparing the patient’s appearance to their preselected photos to ensure the final implant choice is the best I can provide to meet their aesthetic goals. Once I finish sizing one breast, I do the same for the opposite breast to ensure the best possible symmetry.
Since I have my own operating room, I have a full range of implant shapes and profiles with the corresponding sizers, so I never have to guess whether an implant will look right. I can see exactly how it looks using the sizer before I open the final implant.
Many surgeons don’t use sizers because it adds time to the surgery. I feel the extra time is worth it for a more aesthetically pleasing and precise result. As I explain to patients, you probably wouldn’t buy a pair of shoes without trying them on, so if I am placing implants in your body for potentially 10 to 15 years, I like to test out the fit on them, too!
Learn more about the steps involved in breast augmentation surgery in this article from the American Society of Plastic Surgeons.
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Published: 8/30/2011, Updated: 9/30/2020