When Size Matters: Choosing the Right Breast Implant for You

For some women, deciding to have breast augmentation is the easiest part of the process. Choosing the right size breast implant can take a little longer.

Let's face it: in a breast-obsessed society, bigger usually equates with better. But is it really? That depends on your individual taste, your body frame and type, and the "look" you're going for. The professional opinion of a board-certified plastic surgeon who's experienced in breast augmentation, coupled with realistic expectations on your part, can help ensure that you'll end up with the bustline you've always wanted.

The keyword here is YOU. Choose a size that makes YOU happy, not your spouse, significant other, family member or best friend. After all, you're the one who will be living with this decision.

Anatomy as Destiny — Still True?

There was a time, not so very long ago, when women lived with the breasts they developed naturally, whether they were happy with them or not. Short of wearing a padded bra, there wasn't a lot they could do to make up for a perceived deficiency in that department.

Those days are over.

Breast enhancement surgery (also known as augmentation mammaplasty) using saline or silicone breast implants makes it possible for women to choose virtually any cup size they desire. It's wise, however, to temper such freedom of choice with a healthy measure of rational thinking, especially when you consider the investment in time, money and personal sacrifice that you'll be making.

Online breast augmentation communities are full of posts from women in the throes of "boob greed" who wish they had gone bigger. Preplanning on your part will go a long way to ensuring that when your breast augmentation experience is over, you'll be happy with the results.

An experienced, board-certified plastic surgeon who specializes in breast augmentation can be invaluable in helping you decide how large you want to go. He or she can evaluate your anatomy and take accurate measurements of your chest and breasts to determine the proper proportions for your frame. The surgeon will also take into account how lax, or loose, your skin is — an important consideration because, for an aesthetically pleasing augmentation, you must have enough tissue to cover the breast implants.

Forget A, B and C and Think cc

Although bra cups are sized A, B, C and up, breast implants are not. Welcome to the world of cubic centimeters, or cc for short.

Cubic centimeters are the metric volume measurement used to define the capacity of a breast implant. One cubic centimeter equals a milliliter, which is the volume measurement used in the medical world.

Breast implant sizes for both saline and silicone range from 120cc to 850cc. To give you some basis on which to compare sizes, the difference in volume between a 300cc implant and a 360cc implant is just two ounces.

Obviously, the breast size you start with will influence the implant size you choose. If you start as an A cup, you'll need more cc's to take you to a C cup than a woman who starts as a B cup.

The Rice Experiment

One easy way to become fluent in cc and get a handle on what size implant is right for you is to do the "rice test."

Begin by fashioning a substitute implant out of a knee-high stocking and a supply of uncooked rice. A good size to start with is 300cc (30cc = 1 ounce, so 300cc = 10 ounces). Using a measuring cup, portion out 10 ounces of rice, pour it into the stocking and tie off the top. Place the stocking inside your non-padded bra and try it on for size. You can easily add or subtract rice to try on different sizes.

Try on your clothes with the rice substitutes in place to get an idea of how you'll look with larger breasts. Pay particular attention to how the fuller bustline looks compared to the rest of your figure. Is it in proportion? Add some more rice if it appears too small. If your breasts appear to overwhelm the rest of your body, be realistic about whether that's the look you really want and can live with for the rest of your life.

After you pass the rice test, you'll have some idea of a starting size for your implants. When you go to a consultation with a plastic surgeon, he or she will have actual breast implants that you can try on during your visit.

It's important to note that volume refers to size, not breast shape. Breasts that have sagged over time may need a breast lift in addition to breast augmentation to achieve the look you want.

Establishing Limits: When Is BIG too Big?

One way to answer this question during the breast implant selection process is to settle on a size that you think is right and then bump it up a notch. Try the next larger size, take a good look in the mirror and scrutinize how it looks and feels.

If you have a close confidant who knows you well, you may want to get his or her opinion as well. Consider outside advice, but remember that the final decision should be yours alone to make.

Keep in mind as well that the top reason women give for seeking revision breast augmentation is that they didn't go big enough the first time around. Additional surgery means greater expense, increased risk and another round of recovery time, so try to eliminate all doubts about the outcome of your initial surgery before it starts.

Discuss Your Goals with Your Surgeon

Once you think you've made your decision, it's time to run it by your plastic surgeon. Talk to him or her about your preferences on breast size. Some patients find it useful to bring in pictures of breasts that they find appealing. Be as specific as possible about what you like about them, but realize that your own "after" pictures will reflect your uniqueness.

After you've made your case, listen to what your surgeon has to say. If his or her professional and experienced opinion is that your selection is too big for your frame, pay close attention to the reasons why. On the other hand, he or she may suggest that you can go larger and still get excellent results. Your consultation should be a give-and-take arrangement that's open and honest so the two of you can agree on the best outcome available.

With the size and type of implants decided, your surgeon will have opinions on the best way to incorporate them into your body. Considerations include the projection or profile of the implant (how far it protrudes from your chest). Profile types (high, moderate or low) are matched to the width of a woman's chest. High profile implants, for example, allow more volume in a narrower width — great if you're narrow through your ribcage, perhaps not so much if you're broader. Your surgeon should provide more than one choice when it comes to profiles so you can agree on the best aesthetic result.

Two other decisions your surgeon can offer guidance on are implant surface and shape. The basic surface choices are smooth and textured, and each has its pros and cons that should be discussed. Available shapes include contoured (anatomical, teardrop, biodimensional), which are shaped like a natural breast and considered more anatomically correct, and round, which are more spherical or circular. Again, the pros and cons of each shape should be covered by your surgeon. The final choice will be dictated by such factors as body size and shape, skin quality, personal preference and your expectations.

If you're looking for just a modest increase in size (less than one cup), or you're interested in smoothing out slight imperfections in your breasts, breast augmentation fat grafting may be the choice for you. Not all plastic surgeons perform this procedure, but it may be worth discussing this possible option with your surgeon because it doesn't require invasive surgery or extensive recovery time.

Choices, Choices and More Choices

By now it should be clear that deciding on the right breast implant size for you is fraught with important choices and considerations. This is not a one-size-fits-all proposition, at least not if you want to be completely happy with the final results.

Make your decision a personal one, not one based on what your friend or neighbor would do (or did). Your choice is best made in consultation with an experienced, board-certified plastic surgeon, preferably one who has done many breast augmentation surgeries and has the before and after photos to prove it. Rely on his or her expertise, keep your expectations realistic, and your chances are excellent that you'll get the results you're seeking.

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    Joshua A. Greenwald, MD, FACS

    Greenwald Plastic Surgery
    166 5th Ave
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    New York City, NY 10010
    (914) 421-0113
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    Joshua A. Greenwald, MD, FACS

    Greenwald Plastic Surgery
    10 Chester Avenue
    Second Floor
    White Plains, NY 10601
    (914) 421-0113
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    Bahman Guyuron, MD

    29017 Cedar Road
    Lyndhurst, OH 44124
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