A Matter of Size

Hint: Size DOES Matter

June 30,2009

Whoever said size isn’t important has never dealt with breast implants. One thing I know for sure, after 15 years and thousands of breast implants, is that size does matter. It matters a lot. If you don’t get the size right, you probably won’t be too happy with the outcome of the procedure. In fact, I advocate that women who choose to have breast augmentation choose the best size implant and then work every other decision around that decision.

This is not to say that bigger is better. In fact it is not. The important thing about breast implant size is to select the best size for each woman. This is where things can get a little tricky, because women are all so different in where they start and where they want to go with breast size. For example, I could have 10 women walk into my office who have identical bodies, and each could choose a different size breast implant, and each could be happy with her selection. This is because a single size is not necessarily appropriate for a given body or breast size. Each plan must be individualized to that woman’s personal goals of how big she chooses to be, taking into account where she begins.

In order to find the size that is best for any given woman, I recommend the following steps:

1. Use silicone sizers. Even if you want saline implants, silicone sizers are the best. I used to recommend rice in baggies, but it just does not conform to the breast the same way. When using sizers, wear a tight-fitting sports bra (preferably 2 tight sports bras). The reason for the tight sports bras is because anything else will allow the sizers to appear larger than they actually are. Hence, a woman wearing looser bras or a cupped bra is very likely to select a size that is smaller than the size she truly desires.

2. Wear several different tops with your breast implant sizers in place to see how you look. Keep in mind that tighter clothes will always make you appear larger, and loose clothes will always make you appear smaller – no matter what size you select.

3. You may end up liking several different sizes. This is common. I recommend that you select the largest of all implant sizes that you like, stopping just short of the first one that is too big. This is soooo important. Here’s why: most of my patients are sitting on a fence with implant size. They want to go large enough so as to make the operation worthwhile, but they do not want to go so large that others notice or that they feel uncomfortable or that they are disproportionate. My strongest recommendation for women who wish to strike this balance is for them to select that very largest size that they like – but not one that is too big. Ever since I began advocating this approach, my rate of revision for change in size has dropped well below 1%, whereas the national average for revisions for change in size is between 10-20%. Of the few patients of mine who have chosen to undergo breast implant revision for change in size, half have chosen a larger size, and half have chosen a smaller size.

4. When you are viewing yourself in the mirror with sizers in place, be aware of the constraints of an established self-image which you might need to overcome. This is especially true for women in their 40s, 50s, and 60s who have become accustomed to looking at their modest sized breasts for decades, but it can also be true for younger women. I recommend that when you view yourself with sizers, you try to imagine that you are looking at the body of another woman rather than yourself. This helps make the decision-making process slightly more objective.

5. Bring your husband, boyfriend, sister, neighbor, cat, etc to help and offer their opinions and support, but be careful to avoid putting the size decision on them. This is especially true of boyfriends and husbands who may feel that if they help you decide, they will be to blame if you do not like the final size. So, my advice is that you should bring them along, but do not press them to give you input if they are hesitant to do so.

6. Ask your plastic surgeon to help you correlate breast diameter with implant size if you wish to be proportionate…but be careful with this, as there are many pitfalls with this approach. This may be the topic for an entire blog of its own.

7. Try to avoid using your desired cup size as a way to select implant size, as cup size is not standardized. The main place that cup size is relevant is with regard to selection of implant profile, but again, that is based on other factors as well…perhaps the topic for yet another blog.

8. If your plastic surgeon does not use sizers or if your plastic surgeon tells you that he or she will select your size, be wary. Most plastic surgeons will choose sizes that most women would be pleased with, but this does not help women who fall outside of the bell curve in their desires to be either larger or smaller than “most” women. Also, some plastic surgeons impose on other women their own perceptions of ideal breast size, which can sometimes be alarmingly large or disappointingly small.

Now, having asserted that size is the most important decision in breast augmentation surgery with regard to satisfaction, here are a few caveats:

* Please do not torture yourself over 30cc. For example, if you like the 360cc implant, you will like the 330cc implant as well as the 390cc implant. If you end up deciding that the 360cc implant was too small, then the 390cc implant would have been too small also. If you end up deciding that the 360cc implant was too big, then the 330cc implant would have been too big, also. Thirty cc is a relatively negligible amount, equivalent to 2 tablespoons. So, once you have decided on your implant size (or range), know that in order to change size in any visible way, you should change by at least 100 cc to be able to see the difference. (By the way, cc=cubic centimeter and ml=milliliter. One cc is the exact same as one ml).

* I view each woman as having a range of sizes that will all work well for her and will give equally satisfying results. So when I say that we need to get the size right, I am talking about a range rather than a specific size. That range may be 50-100 cc in either direction of the size selected – even taking into account that the woman selected the largest size that she liked among all sizers.

* Just getting the size right does not guarantee satisfaction, as other issues exist as well. See the rest of this site for details of all of the other factors that play a role in breast augmentation results.

Breast Wishes!
Jean M. Loftus, MD

PS: sorry for the corny sign-off, but I just couldn’t help myself!