The choice of implant size is a major consideration for every breast augmentation patient, for that is the reason they are having the procedure. I would wager that women spend more time on this aspect of breast augmentation than any other, including their selection of a plastic surgeon. As a result, one of the keys to a happy breast augmentation patient is that they have the size that they desire.
There are numerous methods that plastic surgeon use to select breast implant size. For most plastic surgeons, they really do listen to the patients and there are a variety of well established methods that work. None of them are perfect and all involve some level of subjective estimation and some eye for size proportion to body type.
One of the breast implant sizing paradigm shifts that has evolved over the past decade is the concept of putting no larger an implant than the breast tissues can support. For long-term fear of bottoming out and the fact that breasts do change in shape over time for many women, the objective is to avoid a regrettable decision and lower the risks of secondary complications. While there are no long-term complications of how breast implants fare based on size, it would be reasonable to assume that very large breast implants (per the patient’s chest size) will have more secondary problems (e.g., need for revisions and thinning of breast tissues.
While I find in my Indianapolis plastic surgery practice that most women have very size appropriate goals (at least by my view), there are clearly some women that prefer a final result of a much larger breast. In these cases, the plastic surgeon is caught between saying they aren’t comfortable doing it or accommodating the patient. While one could argue that as long as the patient has been apprised of the potential long-term implications of their choice, then the burden of whatever happens is their responsibility. That is usually well and good…until the patient returns with a complication.
So what is the best implant size choice for most women…..or how big should one ‘safely’ go? While different answers will come from every plastic surgeon, I think a good rule is to not put a breast implant in whose base width is greater than that of the natural breast. If the implant starts to violate the axillary space or get in the way of the swing of the arm, that is too big of an implant. Beyond this functional basis, recovery from an implant that is too far to the side (should downsizing ever be done and the pocket needs to be closed down) is always difficult and unpredictable. In essence, this problem is not easily recoverable.
The base width of the breast consideration is one of the primary reasons for having different projections or profiles on the implants. If the size a patient wants is a little too wide, then a narrower width implant with more forward projection can be used to achieve the same volume or size.
In the end, breast augmentation satisfaction is ultimately a combination of the final size and shape that is achieved. Larger breast implants may be acceptable if their widths do not exceed the natural base width of the breast.
Dr. Barry Eppley
Indianapolis, Indiana