(The top photo her implants are 500 cc. In the bottom photo her implants have been switched out to a pair of 600 cc )
The one thing every woman seeking breast augmentation wants to talk about is size. They want to know how do I choose the right implant for each patient. What size implant will they get? How will their cup size change? These and other similar questions have to be covered.
Size is one of the most difficult things to discuss. Breasts have a complex three-dimensional geometric shape, sometimes described as a “truncated cone”, but this is not nearly close to the appearance of a natural breast. If you look up truncated cone you will see what I mean. The character of each woman’s breast tissue is unique to her. Some breasts are very soft. Others are very firm. The skin elasticity varies with size, age, whether she has had children, genetics, and more. Much more.
Describing the perfect breast shape is next to impossible because there is so much variation among breasts and in what any individual finds attractive. For these reasons and more, getting that perfect breast size in a breast augmentation is as much a matter of luck as skill, and is part of the art. A good surgeon with experience, however, should be able to obtain a result that the patient will be happy with nearly every time.
It is important to understand that bra cup sizes are not standardized and should be used cautiously to predict the result of a breast augmentation. Different bras, from different manufacturers may fit patients the same despite being a cup or more different in size on the label. I discourage patients from using cup size as the sole or even primary criterion for judging their result. There is also no way to correlate implant volume with what cup size change this will produce. The same implant may increase one woman by one cup size and another by two, or even more.
There is no way to precisely predict what size implant will make any particular patient fully satisfied. Even if formulas and computer programs could predict the exact right size for any woman (they can’t), this would not necessarily translate to being perfectly satisfied with the result of the actual operation.
I have always advised patients to allow me to size them during the operation. I do this by inserting a temporary “sizer” implant into each breast that I can adjust as much as I wish to see what these do for the breasts. Only then am I comfortable selecting my permanent implants. Using this method, I have only had a tiny fraction of patients return asking for bigger implants. I have only had two patients return asking me to make them smaller (I felt the size I chose looked better than the smaller size they chose, but it isn’t about me). The very few times patients have pre-selected their own implants every one of them has returned seeking larger implants later.
In the photos shown above, I don’t have original photos because she had her breast augmentation performed elsewhere with 475 cc Mentor smooth, round, moderate profile saline implants. Her implants were both filled to 500 cc. Her bra cup size was a 34-36 D cup. She came to me because she wanted more fullness. I cautioned against going too large because this can cause problems with back, neck, and shoulder pain down the road. I changed her out to a pair of 600 cc Allergan Natrelle Inspira Style 20 smooth, round gel implants. These are large implants by any measure, and she is not a big person. This 20% increase of 100 cc did not change her bra size and her cup size today remains a 36 D cup. She feels it added a satisfactory amount of fullness and is very happy.
R. T. Bosshardt, MD, FACS
