Did you know that the reoperation rate for breast augmentation is over 20%? And one of the most common reasons patients get breast implants changed is because they (or, more commonly, their plastic surgeon) chose the wrong size implant. In our opinion, that number is way too high. This blog post will explain why the wrong breast implants are chosen so often. More importantly, we’ll describe a breast augmentation method that finds you the best breast implant size almost every time.
What are the Available Breast Implant Sizes?
Breast implant sizes are measured in cubic centimeters (same as a milliliter). The number of cubic centimeters describes the volume of the filler (silicone gel or saline).
Implants are also described by their profile which is a measure of their outward projection (how far they push forward from your chest.) Low profile implants are relatively flat. A high profile implant is more spherical.
The actual size range varies slightly from one manufacturer to the next.
- Allergan breast implant sizes start at 125 cc and go up to 800 cc.
- Mentor implant sizes range from 100 cc to 800 cc.
- Sientra makes breast implants as small as 160 cc and as large as 700 cc.
These size ranges refer to each manufacturer’s round silicone implants. Saline-filled and/or shaped implants (teardrop) come in slightly different sizes.
The typical breast augmentation procedure in Dallas, Texas uses 300-500 cc implants.
What Factors Determine the Best Breast Implant Size for Me?
The right size breast implants for you depend on two things - your anatomy and your aesthetic goals.
Your Anatomy
Your chest has a fixed amount of space available to accommodate breast implants. The limitations are the width and height of your chest and the stretchiness of your breast tissue.
Chest Width
If your surgeon tries to insert implants that exceed your breast width, one or more of the following happens:
- The breast implants get squished from side to side, and your breast assumes an unnatural oval shape.
- The outer edge of the breast implant sticks out too far into the armpit. Most patients find this annoying.
- Your surgeon extends the implant pocket too far across the middle of the chest and risks a symmastia (uniboob). This creates a complication that can be difficult to repair.
Chest Height
The bottom of your breast implant cannot go below the crease underneath your breasts (inframammary fold). If it does, it will produce a double bubble deformity. Most women will find the resulting shape unattractive and will require revision breast augmentation surgery.
If the bottom position of a breast implant is fixed, a larger implant will have to rise higher up the chest wall, eventually going far above the top of the natural breast. At that point, the breasts take on a weird, unnatural shape. The upper breasts look shelf-like and disproportionate, and the nipples appear unattractively low.
Breast Tissue Laxity
Some breasts are stretchier than others. If you have large breasts, have breastfed, or are older, your breasts will probably expand more easily to hold a larger size implant. But every breast has its limit and not all women can achieve their desired size without making their breasts look unnaturally hard and tight.
Your Aesthetic Goals
Though the anatomy of your breasts is important in determining your best implant size, it is not the most important factor. What’s even more important is what you want your breasts to look like.
The first consideration is your breast size goal. Our patients typically want to achieve C to DD cup breasts. Some, however, prefer a more subtle or more dramatic look. During your initial consultation, it’s critical to establish a clear and agreed-to size goal with your plastic surgeon. We’ll discuss how best to achieve that below. Your final breast size is mostly controlled by breast implant volume (cubic centimeters).
Apart from size (and probably more important) are your shape goals. Here there are even more options to consider. You need to ask yourself questions like:
- Beyond my desired cup size, what do I want my new breasts to look like?
- Do I want natural-looking results or large implants that are more obvious?
- How far do I want my breasts to project (stick out) from my chest?
- How round should my breasts be?
- How full do I want my upper breasts to be?
- How firm do I want my new breasts to look and feel?
These are just some of the many factors that determine the right implants for you. Unlike size, breast shape is controlled by several characteristics of the breast implants:
Breast Implant Shape
Silicone and saline implants are available in two shapes: round and anatomic (teardrop). Round implants produce a uniform silhouette that looks full from any angle. Anatomic implants have a sloped teardrop shape. They are fuller at the bottom and pointier at the top, resembling a larger, natural breast.
It seems like the shape of your breast implants would be the most important controller of the shape of your new breasts. In reality, it has the most negligible effect. Let’s look at the factors that matter more.
Breast Implant Filler
Breast implants can be filled with salt water (saline) or silicone gel. Size for size, saline implants will produce a rounder, firmer breast than silicone gel. The saline breasts will look and feel less natural and have sharper, more defined borders.
Even within the world of silicone gel implants, there are choices to be made. Though all silicone gel implants in the U.S. are gummy bear implants, there are different levels of “gumminess.” Multiple thicknesses of silicone gel are now available for breast augmentation surgery. Allergan offers three gel thicknesses in all implant sizes and profiles - Responsive (the softest gel), Soft Touch (a thicker, firmer gel with better shape retention), and Cohesive (the thickest gel).
Figure 3 Shows the effect of increasing gel thickness on breast implant shape. A thicker gel produces a rounder, fuller upper pole (the part of the breast above the nipple.) This can be used in surgery to control the roundness of the breast.
Breast Implant Profile
Figure 1 shows Allergan’s five profiles for their round breast implants. Sientra similarly provides five profiles that they call Low, Moderate, Moderate Plus, High, and Xtra (their spelling, not ours) High Profile implants. Mentor offers four profiles similar to Sientra’s minus the low profile. The absence of a low-profile implant is not an issue since its very flat configuration is rarely what women want.
By varying the implant profile during breast augmentation, plastic surgeons can control several aspects of breast shape:
- A higher profile implant will produce a rounder breast than more moderate profile implants.
- The higher the profile of an implant, the more the breast will project outward from the chest wall.
- High profile implants have narrower base diameters (footprints) than low profile implants. In many women, this smaller base allows plastic surgeons to insert a larger implant and produce a bigger final cup size.
- Using different breast implant profiles on each side is one technique your board-certified plastic surgeon can use to correct asymmetrical breasts.
Breast Implant Size
The size of the implant used in your breast augmentation surgery doesn’t just determine your final cup size. Implant sizing is one of the key elements affecting your breast shape.
As the implant sizing increases, several things happen to the shape of the breast:
- The breast grows wider, occupying more space horizontally across the chest. Eventually, the outer edge of the breast extends past the edge of the chest wall, creating what is commonly called “side boob." As the implant grows beyond this size, it runs out of space and begins to get squeezed horizontally Into an unattractive oval shape.
- The breast projects more, extending further forward from the front of the chest. How far the breast can project depends on how elastic the woman’s breast tissue is. Women who have previously breastfed can usually achieve more projection. Most women can also achieve more projection as they get older. An implant that projects more than the tissue will stretch will distort in unpredictable ways and often produce an oddly-shaped breast.
- The top of the implant extends higher and higher up the chest. As this happens, the top border of the breast rises and becomes more clearly defined. The upper breast contour (upper pole) becomes rounder and more protruding. This makes implant size a potent tool for influencing breast shape. The limit here is in maintaining the right proportions. If the top of the breast is too close to the collarbone or if there is too much breast above the nipples, the breasts will look unbalanced and unattractive.
How is Breast Implant Size Usually Chosen?
A system for choosing your best breast implants must accomplish two tasks:
- Establish clearly understood size and shape goals shared between you and your surgeon.
- Accurately translate those size and shape goals to the right implant size and style for your plastic surgery procedure.
Plastic surgeons use several implant sizing methods. We’ll review the effectiveness of each in achieving our two tasks.
Method One: Bra Cup Sizes
Having their patient request a specific cup size is the most common way plastic surgeons select breast implants. And it’s the worst.
At the initial consultation, a surgeon using cup sizes will ask you what size bra (C, D, DD, etc.) you want to fit after surgery. Based on your choice, he or she orders the breast implant size they estimate will meet that goal. Those are the implants inserted at your surgery.
Cup sizing fails miserably at communicating size/shape goals between patients and surgeons. To see why, look at Figure 4 above. It’s a screen capture from a Youtube video about 100 celebrities with D-cup breasts. I don’t know who these women are, but I do know they have three very different pairs of breasts. Now, you could argue that Traci Bingham’s breasts are DD cup or even larger, but it doesn’t really matter. The point is that bra cup sizes aren’t standardized and are vague. So when you tell your plastic surgeon you want D-cup breasts, you’re picturing something in your mind. Your surgeon is picturing something in their mind. But the odds are that those two pictures aren’t the same. Even more problematic is that when you have your plastic surgery, you will end up with your plastic surgeon’s idea of a D cup, not yours.
Method Two: Bra Testing
Doctors using the bra testing method provide their patients with an oversized brassiere and a set of various-sized breast implants. The patient places the various implants in the bra, one by one, and looks at the result in a mirror. She chooses the implant that most closely resembles the look she wants, and that size and shape will then be inserted at surgery.
Although this seems more scientific than simply naming a bra cup size, this method fails just as badly. The problem is that breast implants placed inside a bra, under your clothes, in front of your breasts do not look anything like the way they would appear when implanted inside your breasts. And there’s no reason they should. It is no different than going to a department store and trying on a dress by holding it in front of your body. It tells you nothing.
What’s worse is that bra testing doesn’t even fail in a consistent direction. Sometimes it predicts a larger implant than is actually needed, and sometimes, a smaller one. So while bra testing provides your plastic surgeon with an implant size to use, this data is useless since it is often wrong.
Method Three: Software
There are several software packages designed for plastic surgery imaging. These digital rendering programs function like Photoshop, altering patient photos in the specific ways a plastic surgeon might need. Most include a breast implant sizing tool. To use this, the surgeon selects the different implants from a menu, and the program enlarges and reshapes the patient’s breasts based on its best simulation of what the results would be.
We have evaluated several of these software programs and tested one for an entire year. For breast augmentation, our goal was to see how accurately it predicted the correct implant choice. To do that, we recorded the software‘s prediction and then compared it to the actual size implant we had to use to achieve the patient’s desired look. The results were not impressive. The software rarely predicted the correct implant style and size. Even worse, it was incorrect in unpredictable ways. Its predictions were sometimes too large and sometimes too small and by varying amounts. In our analysis, the software was not helpful in predicting implant size. We would advise you not to use it to choose your breast implants.
Method Four: Measurements
Most plastic surgeons measure your breasts during your initial consultation. Commonly used measurements are the distance between the top of your sternum and your nipple, your nipple and the bottom of your breast, and the width of your breasts. These measurements are used to document the results of your surgery and also to help with implant sizing.
Some surgeons use only measurements to choose implant size. This is called dimensional analysis. Some simply match the breast implant’s width to the breast’s width (the base diameter.) Others use elaborate systems, including body size and tissue elasticity estimates to predict the correct implant.
Most of these measurement techniques work in the sense that they predict a breast implant that will be appropriate for the woman. Choosing an implant matching the dimensions of the patient’s breasts will often produce an acceptable result. However, it may not produce the best result. There are two problems in relying on just measurements to pick your implant size.
The first problem is that dimensional analysis assumes that each patient has a correct implant size based on her chest and breast measurements. This is never true. For every woman, there is a range of implant sizes and styles that will work. Go above the upper limit of the range, and you’ll get a result that’s disproportionate, excessively fake, or just ugly. Sizes below the bottom end of the range may give you a result so subtle the surgery will have seemed like a waste of time, as if your breasts were left unchanged.
Somewhere in your correct implant range lies the best implant for you – the size and style that will give you the prettiest breasts - the breasts that make you maximally proud. Unfortunately, measurements alone won’t find this size. Measurements will get you into the correct range but do not find the optimum size within it.
The second problem with measurements is that they ignore your goals and desires. The width and height of your breasts tell us what your body currently looks like. But they don’t tell us what you want it to look like. Look at the six questions listed under the “Your Aesthetic Goals” section. If your surgeon uses only measurements, they are addressing none of these issues. Dimensional analysis picks an implant size for you, and that’s what you get. It’s a system that pretends that what you want your breasts to look like doesn’t matter.
But, of course, what you want your breasts to look like matters a lot. Every breast augmentation produces larger breasts, but if it doesn’t produce the larger breasts you want, you’re not likely to be satisfied with the result. This is why we don’t recommend choosing your implants by measurements alone.
Three Steps to the Right Implant Size
Dissatisfied with the conventional ways of choosing breast implant size, we looked to create a better, more reliable system. Over the last 20 years, we have developed and refined a 3-step method that accurately predicts the breast implant style and size most likely to delight you. The system is not complicated, but it does require extra time and attention to detail to yield its results.
Step 1: Measurement
Yes, two paragraphs ago, we said that measurement does not correctly choose breast implant size. But it does help define the range of breast implants that might work for you. And it does offer, at least, a reasonable starting size for determining your best implant.
We use your measurements mostly to eliminate breast implant sizes that will be too large or too small to please you. But frankly, the next two steps in the process are much more important.
Step 2: Goal Photo Analysis
Prior to your appointment, we ask you to select and send us several photos of women whose breasts you like. We review these photos with you during your consultation.
This photo analysis is incredibly valuable. First, just selecting the photos forces you to think clearly about what you want your breasts to look like. We then review the photos with you by asking specific questions about the breasts that give us a deeper understanding of your goals. By the end of your consultation, we know very specifically what size and shape you like - the guesswork has been eliminated.
By the time the photo review is finished (it’s usually the longest segment of the consultation), we’ve clarified your breast goals, and we’re sure that we understand what you want. This is critical! If your surgeon doesn’t fully understand the results you want, you’re not going to get those results.
Step 3: Operative Testing
With your photo analysis done, we can go into surgery precisely knowing your desired breast size and shape. In the operating room, we need to find the breast implant style and size that will most closely deliver the results you want. There’s only one reliable way to do this - sizers.
The implant companies all make test versions of all of their implant sizes and styles called sizers. They look and feel like the real implants. They’re sterile, so they can be temporarily placed in your breast implant pocket and evaluated. Too big? Too small? Right shape? These questions can be answered with certainty, and we can find the best breast implants for your augmentation.
Once we’ve chosen the perfect sizers, we remove them and replace them with regular implants of the same size and style. Like goal photo analysis, sizer testing eliminates the guesswork in breast augmentation..
Results
The reoperation rate for breast augmentation is 20% and the most common reason for additional surgery is to change implant size. Our breast augmentation reoperation rate is less than 0.5%. We have reoperated to change implant size in 0.1% of our cases.
The three steps of Measurement, Photo Analysis, and Operative Testing has worked for our patients 99.9% of the time.
To be transparent, we are not the only practice that uses measurements. Most do in some way.
We are not the only practice that uses sizers, but most do not. It is costly to stock a full set of sizers and all the real implants needed to make this system work. We think the cost is worth it. It takes additional O.R. time to test with sizers. We think the time is worth it.
And we are not the only practice to review goal photos of breasts in the consultation. Most do not, and we’re not aware of any who do it in the structured way we do. Doing this requires a longer consultation. But again, we think that a little extra time and money to get your breast augmentation right the first time is time and money well spent.
We put this level of thought and care into all our services. If you’d like to know more about breast augmentation or other surgeries we offer, please call or text us at 214-814-8821.
