The consideration of implant size in breast augmentation is one of the key issues every woman carefully ponders. Prospective patients pour over before and after photographs on the internet and other medioums in an effort to gather a perspective on what would look good on them. Patients come to express their breast desires to their plastic surgeon by bra cup sizes, sometimes in volume amounts (ccs or mls) and almost always as ‘I don’t want to be too big’.
While there is no exact science as to selecting a desired breast implant size, there are several concepts that are useful. Not any implant size will look good in every patient. Breast implants must work with one’s existing anatomy to create how the final result will look. These concepts are breast and implant base width, volume to cup size change relationship, and skin stretch.
The base width of your breast and the implant should match within a cm. or so. Every breast implant has a diameter which increases as the implant size gets bigger. The manufacturer has a table which lists all implant widths. You do not want an implant that has a base width wider than that of your natural breast. If you do, the implant edges will not only be visible but the implant will look and feel like it is in the way of the swing of our arm. (e.g., too far to the side) If the implant with the right base width is too small in volume for your final look, choose a larger volume implant that has a higher projection or profile. Higher profile implants, for every size, have a narrower base width.
It takes a much bigger difference in volume to make a change in cup size than most patients think. Patients often labor over 25 or 50ccs in their decision making when such a small volume can barely be seen.When in doubt, always go for the extra volume. (because most patients will overestimate what size effect the implant will have) As a general rule, it takes at least 100 to 150 ccs to make a cup size difference. This will change as one’s chest circumference by bra measurement gets bigger. If you are a 32, it may only be 75ccs. At 34 it may be 100ccs and at 36 and higher it may be as much as 150ccs. If you have loose stretchy breast skin, think a bigger implant size. (but keep the base width of the implant no bigger than your own breast base width)
The looseness of one’s breast tissue has a significant effect on how much implant volume is needed to fill it out. This is known as skin stretch and can be measured by pulling the nipple forward and see how much it moves. If the breast skin is tight, not as much implant volume is needed to fill it out. If one has had children or has had significant weight loss, the breast skin will stretch more. This will take more implant volume to fill out the loose skin.
If you worry about being too big after breast augmentation, as many women fear, remember that implants do not usually appear as large as natural breasts do. This is particularly true in clothes. If you are a D cup bra naked, you will look like a C cup in clothes. Try out some implant sizes in your plastic surgeon’s office. Stuffing an implant in your existing bra is not always accurate, but it can give you a rough idea of how much breast volume is needed to give you the look you want.
Dr. Barry Eppley
Indianapolis, Indiana