Choosing breast implant size, a matter of aesthetics

Surgical breast enlargement enables a woman to choose the breast size that she feels will enhance her body image and self-confidence.

However, some women find that, following breast augmentation, their ideas about the ideal breast size have changed, and this can lead them to request additional surgery. "Additional surgery means additional risks, so plastic surgeons are always looking for ways to help women make better choices about breast size at the time of their initial breast augmentation surgery," says Los Angeles plastic surgeon Peter Fodor, MD, president of the American Society for Aesthetic Plastic Surgery (ASAPS).

A recent survey of 1350 breast augmentation patients showed that, while satisfaction with surgery was extremely high, nevertheless 34 percent of those who underwent re-operation did so simply to change the size of their implants. In most cases, women who change implant size switch to larger implants, says James Baker, Jr., MD, co-chair of the ASAPS Breast Surgery Committee and author of an article on choosing breast implant size that appears in the current issue of ASAPS' peer-reviewed Aesthetic Surgery Journal . He warns, however, that implants that are too large can leave a patient looking "proportionally disfigured." "If a patient demands a size unsuited to her body type, I cannot in good conscience perform the surgery," he says.

While there are different opinions on selecting the appropriate implant size, most plastic surgeons agree that the base diameter of the breast should be the key measurement determining the selection. "After measuring the breast's base diameter, I hold a clear plastic template over the breast to actually show the patient the implant size that will be most suitable," Dr. Baker explains. "This allows her to see, for example, how an implant that is too large simply won't fit under her breast."

Although the average size implant that Dr. Baker uses today is significantly larger than he used in 1971, when he began his cosmetic plastic surgery practice, he attributes the increase to the body type of the patients he sees today. "Women are now taller with broader chest wall dimensions and larger frames than they had 30 years ago," he says.

Even though implant size usually is best determined by measurement of the breasts, patients who are actively involved in the decision about implant size may be more likely to be satisfied with the results of surgery. How can breast augmentation patients explore their options for implant size before undergoing surgery? Here's some advice from the American Society for Aesthetic Plastic Surgery (ASAPS):

• Be frank and open in discussing size so that there is clear communication, from the beginning, between you and your plastic surgeon.

• Select several photographs from magazines illustrating ideal proportions, and show these to your plastic surgeon as a way to begin the communication process. The examples should be of individuals with a similar body type to yours.

• Don't define your desired breast size only in terms of bra-cup size. Cup size can vary significantly among bra styles and manufacturers.

• Plastic surgeons sometimes have implants in the office that are used for patients to "try on" different sizes by stuffing them inside their bra. Do the same thing at home, using plastic bags filled with oatmeal, and see how various sizes look in different types of clothing.

• Maintain realistic objectives and don't assume that bigger is always better. Implants that are too large not only will upset the aesthetic balance of your figure, they also may be more prone to sagging and ultimately give you a "matronly" look. The best approach is to select implants that will look like a natural part of your body.

"When choosing implant size, patients should be aware that large implants, compared with smaller sizes, have a greater potential for certain types of complications, both in the short-term and long-term," says Dr. Fodor. "Patients who select the smallest implant that will give them a well-proportioned and natural-appearing body contour are making the best possible choice."