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Breast augmentation increases the size of the breasts. In many patients, it also improves the shape of the breasts. The foremost question that patients ask regarding breast augmentation is “what size breast implants should I get”? Choosing a breast implant size can be very confusing. Patients frequently have a general idea of what size implants they want when they come in for a free consultation. Frequently the patient has talked to a friend or family member about breast implant size. Some patients have studied online information to get an idea about what can be achieved. Some patients have done the “rice test.” There are many factors that should be considered when choosing a breast implant size, and these factors are discussed at the free in-person consultation.

Breast “cup size” is not used to choose breast implant size because there is no standardization of breast cup size in the bra manufacturing industry. For example, a C-cup bra manufactured in Japan may not have the equivalent volume of a C-cup bra manufactured in Mexico. In other words, the cup size of bras can vary widely depending on the brands. After breast augmentation there will still be this variation in fit of bras. That said, bra cup size can be used to estimate a starting point for breast implant size.

An important consideration when selecting breast implant size is the patient’s goals. In our office, the patient makes the decision about breast implant size. Patient goals vary from patient to patient as does the choice of implant size. Breast implant size varies widely based on patient goals and the patient’s individual situation. Some patients request a breast implant that would create better proportion. Some patients request an implant that is as large as possible. Patients that have had children commonly want to return to their “pre-children” state. Some patients desire larger breasts but do not want the procedure to be obvious to other people. Other patients state that they want everyone they see to know they have breast implants.

There are several commonly used methods to estimate desired breast implant size. Because breast augmentation is an elective procedure (can be done at any time), there is ample time to choose your breast implant size. Most plastic surgeons have breast implant “sizers” for this purpose. These implants are “anatomic,” meaning they are the shape of the natural breast. These are non-implantable devices that can be placed in a non-padded bra or bathing suit to estimate the desired size. This is the preferred method for some plastic surgeons.

Many patients seeking breast augmentation have significant asymmetry (breasts are different sizes). In this circumstance, patients can try on different implant sizers to help even out the breasts. The type of breast implant also matters, as an estimate of breast size discrepancy can be used as a starting point to choose breast implant size when using saline implants, because saline breast implants are adjustable (to some degree). Then the final implant volume is determined during surgery. Small adjustments of volume are commonly done during surgery with saline implants to “fine tune” breast symmetry. Small adjustments of volume are not possible using silicone breast implants, which is one advantage of saline breast implants. If silicone breast implants are chosen, then the patient’s exact choice of size is used.

Another commonly used tool to determine the desired size is the “rice bag” method. This approach can be done at home to estimate the volume of the desired breast implant. A plastic zip lock bag is filled with rice and placed in the bra to estimate breast implant size, just as with the silicone breast sizers. For estimating size, one cup of rice (not to be confused with breast cup size) is approximately 240 ccs. Because breast implant size is chosen based on ccs, this provides an estimate of the desired volume of the implant. The chart below can be used to estimate different breast volumes.

Another method for estimating size is computer imaging. The advantages of computer imaging are ease of use and goal setting. The disadvantage of computer imaging is that a computer cannot exactly predict the exact appearance of a patient after surgery. Computers cannot exactly predict the appearance of a patient after breast augmentation because it does not take into account many factors, including but not limited to the state of the patient’s tissues or chest anatomy, the experience of the surgeon, variables of wound healing, and activity of the patient. Computer imaging could create false expectations from an implied guarantee of the images, which is one reason some plastic surgeons choose other methods to estimate the breast implant size.

There are many acceptable methods of choosing a breast implant size when considering breast augmentation. The protocol below is used in our office. The patient predetermines the breast implant size before the day of surgery. For most patients there is no “best exact size” of breast implant. Not one breast implant size will look the same on every patient. In other words, breast implant size is relative to the patient wearing it. For example, a 300cc size implant on a petite patient with a small chest width will not look the same on a patient who is taller, weighs more, and has a larger chest width. Because of this, there is a range of implant sizes that is acceptable, and a large range of breast implant sizers for this purpose.

Step 1 – Patient’s Goal Size

The patient is asked for a general description of her goals and what “cup size” is desired. If the patient desires a B-cup size breast, then the breast implant size recommended is in the low end of the acceptable range. If the patient desires a C-cup size breast, then the breast implant size recommended is in the middle of the acceptable range. If the patient desires a D-cup or larger size breast, then the breast implant size recommended is in the upper end of the acceptable range. Again, this is only a starting point in selecting the final breast implant size.

Step 2 – Surgeon’s Recommendation

An implant size is recommended based on the patient’s desire to be a B cup (lower range), a C cup (middle range), or a D cup or larger (upper range). The breast implant size recommendation is based on other factors other than the patient’s expressed goals. The width of the chest wall is considered which can limit the size of the breast implant in some patients. The thickness of the breast plate (tested by the “pinch test”) can also affect the size of the recommended breast implant size. Patients with a thin breast plate on the pinch test (less than 2 cm.) may have a better result with a smaller breast implant. Patients with breast sagging is another example of a situation that might affect the size of the recommended breast implant. Your plastic surgeon will help you determine the best option with regard to these factors.

Step 3 – Try on for Size

The breast implant sizer is placed in the patient’s bra to approximate the size the breast will be after breast augmentation. The patient can go down in size or up in size to meet her goals. If the patient wears more than one bra style, then the breast implant sizer can be tried in those bras as well. The sizer can also be tried into a bathing suit or other clothing that the patient wears, such as a tube top or a camisole. The implant size chosen should be at least large enough to make a noticeable difference, but not be so large as to cause any of myriad problems caused by excessively large implants. When choosing a breast implant size, it is important to understand that the goal is to increase the volume and shape of the breast, and not to look like another person. The breast implant changes the present anatomy but does not create a new breast.

Step 4 – Adjust for Symmetry

After a breast implant sizer is chosen, the breasts are then examined for symmetry. If a small size discrepancy is visible, the different implant volume may be chosen to minimize the asymmetry. In some patients the breast asymmetry may exceed the volume range of a specific saline breast implant and a different size implant (different range) may be needed to minimize the asymmetry. The final volumes are determined as chosen by the patient.

Step 5: The Surgery

After determination of the patient’s chosen breast implant size, if saline breast implants are chosen, the final adjustment of volume is discussed. Fine adjustment of the breast implant volume is possible only with saline breast implants (not silicone), which are filled at the time of surgery. Because silicone breast implants are “pre-filled” during the manufacturing process, adjustment is not possible at the time of surgery. The options related to the final volume are to place the saline breast implants with the exact volume chosen by the patient, or allow discretion of fill volumes by the surgeon at the time of surgery. The latter allows fine adjustment of the breast implant volumes at the time of surgery.

For more information about breast implant sizing, or any other aspect of breast augmentation, please contact our practice to schedule a complimentary initial consultation with Dr. Herring.