What size is right for me?

For every patient undergoing breast augmentation surgery, this is THE question. Everything else is secondary, although we explore and attempt to answer every question.

So how do I approach this so very important matter?

Most plastic surgeons use an approach to size that takes into account more than how many cc’s (Volume). But most patients ultimately think volume=size. (And they come in saying things like, “My friend had 350cc’s and I like hers”).

Implant volume is only one factor. How much breast tissue you have before surgery is very important. After surgery, your size will be the combined effect of how much natural tissue you have plus the implant volume.

But patients ask me what I recommend, and there are some important considerations. beyond implant volume. I also look at the dimensions of your chest and those of your breasts.

During the initial consultation I take  measurements that are useful in the sizing process. We look especially at the distance from the nipple to the crease under the breast (NAC – IMF) and the base diameter (usually distance from breast bone to armpit edge), as well as how far the nipple is from the top of the breast bone (SN – NAC).

The distance from the nipple to the bottom of the breast (the NAC-IMF) tells me the largest implant width I can use. Too large an implant will make the breast top heavy, and force the nipple downwards.

Some women have a breast that is much narrower than the space from breast bone to edge of the armpit. These patients with “constricted base” (sometimes called “tubular breasts”) are a particular challenge, requiring special treatment.

When my staff and I size my patients for breast augmentation, we want to fulfill an idea each woman has in her mind, of her ideal. Some women want only a modest increase, and for them, we absolutely avoid going too large. Others come in wanting to be very large, and for them, while we try to give them a very satisfying result, there are issue with big implants that have led to the expression “Big implants, big problems” which is well known to plastic surgeons.

We try to get an idea of what size you have in mind by putting you into a bra of the band width and cup size you desire. The band width is what you  should be wearing now. If you are a 34B, you will still be a 34 after surgery (although more than 75% of women wear the wrong size according to professional bra fitters). Your natural breast occupies some of the bra cup, but the cup is often partly empty, without padding. I tell patients I provide you with “internal padding”. Then we fill the bra cup  to the extent you desire using sizing devices and measure the volume we have added. Most of the time we add enough volume so you feel it is a little too much and then reduce this slightly. For women who fear being too large we add only enough to make them comfortable.

If the volume you desire is high, so that a moderate profile (the usual) implant wouldn’t have enough room, we use a narrower base/diameter implant (high profile). If the volume is still too large to fit, I will intervene and tell you what is the limit, beyond which there is a higher likelihood of poor outcome.

Hi Profile implants don’t go higher up the chest wall. They protrude more. Most patients want “upper pole fullness”. This doesn’t come from using Hi Profile implants.

While all this sounds terribly complicated, it really comes down to a matter of balance. We balance the volume desires with the physical dimensions and come up with the best possible combination of those factors. Sometimes this may mean adjusting the volume of the implant up or down a little, and the final decision on  exactly what implant needs to be used will be one I will need to make.

Ultimately, it will be with the aim of giving you the greatest chance of satisfaction.

Remember, the shape of your breasts before surgery is the most important factor determining the shape of your breasts after surgery.

If you have any questions about breast augmentation sizing, our experienced and supportive staff at our Vancouver clinic is always available. Please call us at (604) 874-2078 or you can book your consultation today.

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