How Do I Choose the Right Size Breast Implants?
There definitely is a rule of thumb for choosing the right size implants. Choose the size that makes you feel how you imagined you would feel if your breasts were always the size you wanted. Sounds simple, simplistic?
Let’s see what the process is for deciding what implant suits you. This is going to be a decision with long-lasting consequences and you want to avoid a re-operation just because you have found out after surgery that the size as not right for you. In the Mentor core study, at 3 years nearly 15% of re-operations were done for change of size or style). We want to avoid this.
First recognize that every woman is different in how she sees herself, and what is too small for one woman may be too large for another. When a woman first starts trying on gel implant sizers in the appropriately sized bra, she may be quite startled and even anxious about the difference. This is common. After a few minutes, the idea that this can actually be how you will look without artificial padding seems to overcome this initial reaction.
Your surgeon is trying to be sensitive to your feelings about what will work for you. Women commonly indicate that they want something natural, that they don’t want anyone to know they have had surgery, that they want to be conservative because of concerns over how they will be perceived by family, friends or at work. But again, this is not everyone. Some women are not “conservative”. They know what they want and if it is a larger look, they know that is what they will have. After all, this operation is for your happiness and satisfaction only.
The sizing always begins by taking measurements of your breast base width and evaluating your soft tissue envelope. These measurements set the reasonable limits for implant width. This can be done by direct measurement as I and most plastic surgeons do, or with a computer-imaging device. I have found that the 3-D tactile and visual information that women get from using the actual implants in the form of gel implants sizers is very important. This virtually ensures that the choice will not be too large or too small.
During the sizing process, what you tell us, as you feel more at ease, helps refine the eventual decision. Your preferences can be reviewed repeatedly by you alone or with feedback from a friend, relative, spouse or significant other. There is no rush.
For example, let us say your breast width is 12 cm. We know what size implants, both medium and high-profile will fit in that diameter (we rarely use low-profile implants). A computer-imaging device would show the same information.
We know from what you have told us so far which direction you are leaning, more conservative, less conservative. We encourage you to bring to the consultation several different items of clothing so you can see how you look in the clothes you usually wear.
Based on all this initial input, one implant size would be chosen to begin with. Sometimes the patient says it is the perfect size. But we know that sometimes when we give you the opportunity to try one “a little larger” that you may not see much difference and say that this one is “perfect” too. This process gives you the chance to try out how an implant looks and feels with no pressure whatsoever. A little bigger, a little smaller, until you know very well what implant size is just “too big” and which is “too small”.
Most women will narrow the size down to 1-2 sizes fairly quickly. They then have the opportunity to go home, think about it and look at the cell phone pictures that they may have taken to review or show someone close to them. If a woman has a moderate amount of breast tissue, we always tell her that there can be perhaps 10% loss of volume after a year, from the effect of the implant on overlying breast tissue. There seems to be a small degree of thinning of the overlying breast/skin envelope. Since 10% of an implant in the 250-400 cc range is about the same as the difference between two sizes, this information sometimes makes a woman feel a little bit more comfortable in choosing the larger of their two choices, slightly bigger rather than slightly smaller.
Two groups of women who seem to have the most difficulty in choosing the “right” size are the women who are very afraid of being too large and those who want to be quite large. The former tend to want implants in the 180 to 250 cc range. These are the smaller implants and are often chosen by slim or athletic women who definitely want to look natural and not be seen as having had breast augmentation. They are usually happy with the results, but in my experience are more likely after the surgery and living for some time with the implants, to feel that they should have gone bigger, or request re-augmentation with larger implants.
Women who are comfortable with the larger sizes, 400-500, are usually very comfortable with their choices. However I have noted that women in this group are also more likely after surgery to wish they had had a larger implant. It is important to realize that trying to place an implant that is wider than the internal breast base diameter is more likely to lead to stretching of the skin, numbness and eventual re-operation. Therefore, it is not recommended. Sometimes women who request a “D” cup find that they could have gone even larger. Since we never want to make someone larger than they wanted (a great source of unhappiness), we have to spend more time and more than one sizing session before coming up with the final decision.
If an implant that fits the base diameter is smaller than preferred, then the patient can see if she likes the look of the high-profile implant. A high-profile implants allows more volume in the same diameter than a moderate-profile implant. For example, instead of a 350 cc implant, the same width might accommodate an implant that is 450 or more. The difference is that the high-profile implant will not come out so far at the sides and will project forward more. Then, it is important to decide if the patient even likes the look of the high-profile implants. This is an individual taste, which is easily determined by trying on the different implant styles. We offer every patient the chance to see what she thinks of the moderate and high-profile implants. Some women immediately know that they do not like the look of high-profile implants, while some women find they prefer them.
In summary, whether the sizing is done by computer or by use of sizing implants, if a woman has the chance to both see and feel the implants, and feel that she is in control of the process, the outcome will be good. If there is uncertainty, particularly a lot of uncertainty, then it is time to step back and use the information gained in this sizing process to re-evaluate what one really wants. Sometimes, after sizing the patient becomes very energized and enthusiastic, and sometimes she needs to stop and think for some time. In the end, by giving yourself time to adjust to the potential new image, you are likely to be happy and not to have regrets about your size choice. The doctor and staff can help, but should be non-judgmental and supportive, and not try to influence you or try to make your decision for you.
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