One of the most important considerations that a patient has about the breast augmentation procedure is the final size that the breasts will be. Obviously, this is controlled almost exclusively by the size of the breast implant. I have previously discussed in a prior post about the differences between saline vs. silicone breast implants. The different filler material of a breast implant has no influence on how large the breast will be. Both materials are put in by volume, usually noted as ccs, so both achieve the same result in the end if the size (fill volume) of the breast implant is the same. They are some shape differences of the breast implants, known as amount of projection, that can affect how the breast looks, but still the most important consideration of a breast implant is size.
How does a patient or plastic surgeon determine the size of breast implant that should be used? This is a somewhat controversial topic and may sometimes conflict with what the patient wants and what the plastic surgeon is willing to do. In the past few years, the sizing concepts of the width of the chest wall and how much size or weight of a breast implant that the breast tissues can support has come into vogue. There is no question that over time, a large breast implant may ‘drop’ or sag if it exceeds what the breast tissues can support. These are somewhat complex formulations that have been derived, based on patient measurements and amount of breast tissue present, that arrive at a ‘good’ or maximal breast implant size for each patient. In many average-sized patients, this is going to be in the range of 300 – 350ccs. The taller and larger a woman is, the larger the breast implant can be based on these charts. Whether this approach achieves what the patient wants or achieves the breast ‘look’ she is after from the breast augmentation procedure is another matter.
My approach to breast implant sizing in breast augmentation is to have the patient first bring in some pictures of the breast size that she wants. These pictures have to be pictures with the breasts exposed and they can be obtained off the internet or magazines. The patient should pay attention to the size of the breasts and not what the rest of the woman looks like. She should avoid the common method of discussing breast size in cups. Bras and cup sizes are highly variable and open to interpretation. What a medium C cup is to one patient may be different than someone’s else perception of a medium C cup. We are after a ‘breast look’, not really focusing on cup size or fill volume. If your friend has 350cc breast implants that look good on her, it is likely that has nothing to do with you, unless you have exactly the same body and the same breasts! Based on these pictures and breast and chest measurements, I then attempt to find a breast implant, usually starting with the width of the breast implant (off of a chart) as the most important starting point. These manufacturer charts, as we have previously discussed, are a good reference but are not absolute in my mind. In the end, the most important determination for me is how close does that come to the pictures that the patient presents. The final breast implant size, however, is determined during surgery. The pictures are taped up in the operating room and serve as the final reference for breast implant selection. The final breast implant must create the ‘look’ that the patient desires, regardless of manufacturer charts.
Dr Barry Eppley
Indianapolis, Indiana