If you're thinking about having a breast augmentation or breast reconstruction surgery with implants, there's bound to be a never ending stream of questions going around in your mind. One of the most essential to answer when it comes to breast implants, in particular, is which one is right for you. Whether you already have a cup size in mind or you're looking for guidance, a board certified plastic surgeon is the best placed to advise on which implants will be best. To better understand how they go about figuring out the ideal implant and sizing for each patient, we spoke to three top plastic surgeons.
Factors to Consider When Choosing Breast Implants
From size and shape to look and feel, there are a number of factors that help determine which implant is right for you. Three of the most important:
Chances are, if you're considering having a breast augmentation, you already have an idea of the cup size you'd like to be after surgery. "Most women have this ‘American ideal’ in mind,” says Jacob Unger, MD, a board certified plastic and reconstructive surgeon in Nashville. What is that perceived ‘ideal’ you may ask? “Most everyone — regardless of their height, shape, size, or actual desires — will say ‘full C,’” he shares.
If you’ve ever been bra shopping, you know the issue with cup sizes is that they are rarely created equal. To avoid confusion, it may be better to bring visual inspiration. After all, a picture is worth a thousand words. “What is more effective is having patients bring in photos of their desired result and working with them to select an implant that will help them achieve their desired result,” notes Umbareen Mahmood, MD, a board certified plastic and reconstructive surgeon in New York City. She calls these images “wish pics” and suggests all patients bring them to their consultation.
While conversations about aesthetic goals will begin during your initial office visit, some surgeons prefer to leave the nitty gritty of sizing to future appointments. “I currently do sizing as a separate office visit where the patient brings a bra and top that they would like to ‘fill out’ and we try inserting different volumes of sample breast implants until we are happy with the look we achieve,” says Lauren Chmielewski, MD, a board certified plastic and reconstructive surgeon in NYC. As she explains, there are many methods surgeons use when working with patients to choose the “most flattering implant size.” Those include the so-called ‘rice test’ (“using a bag of rice to experiment with different implant volumes,” she says), the ‘high five’ calculation (“a specially formulated set of measurements,” she notes), and 3D modeling to name a few.
As one beauty editor who underwent a breast augmentation procedure during the COVID-19 pandemic wrote of her experience, finding the right implants was less about size and more about look, feel, and, yes, proportion. After trying on an array of implants, she determined 250-ish CCs looked most proportional to her body. Her surgeon took note of her preference, but he would ultimately decide during surgery what worked best. Finding the right implants for patients is part of the art of aesthetic medicine.
Each surgeon has their preferred method of determining the best implant, but proportion is primordial. “One of the most important factors in implant selection is the base width of the patient’s breast compared to the base width of possible implants,” Dr. Mahmood explains. If you’re curious, she says the base width of the breast is the “width of the chest wall from the cleavage to the outermost edge of the breast.”
In addition to base width, Dr. Mahmood also takes the volume of the implant and its projection into account. “For patients with narrow base widths who desire larger implants, high profile implants are a good option,” she says. “They maintain a smaller width but contain more volume by having an increased projection.”
Similarly, Dr. Unger seeks to balance biology with patient intention. “I determine implant size based primarily on their anatomy, meaning the size and shape of the chest wall and breast envelope,” he shares. “Then, of course, that is influenced by the patient's individual desire.” As he explains, some women “want to be more full” and some women “want to be more subtle or natural-appearing.” Understanding a patient’s preference allows him to “use the more full or less full sizes in the range that will fit their chest,” he adds.
Texture & Feel
It’s one thing to think about what your new breasts will look like, but equally important is how they will feel. “A breast augmentation consultation is not complete without the patient being able to observe, hold, and ‘squish’ each style of implant that I use,” Dr. Chmielewski says. “This helps guide the patient to a feel, shape, and texture that best achieves their goals.”
How your chest feels post-surgery mostly comes down to the type of implant you go for. In Dr. Chmielewski’s opinion, “silicone implants still trump saline” in terms of feel. Dr. Mahmood’s preference for silicone implants comes down to longevity. “They do not need to be replaced every 10 years, as the older generation of silicone implants with thinner shells did, which makes them a more desirable option,” she explains. Another benefit? “There is less risk of implant rippling with silicone implants than with saline implants,” Dr. Mahmood says.
It’s also important to take the patient’s natural breast tissue into account. “I consider each patient's breast tissue firmness or softness when choosing the gel subtype we use,” Dr. Unger notes. A firmer gel, he says, is “more consistent with a more youthful, firm breast,” while a softer gel will feel more natural in a more mature or postpartum breast where “there is more fatty tissue creating softer tissue.” In either case, the goal is to “help [the breast] feel more uniform,” Dr. Unger shares.
Questions to Ask During a Breast Implant Consultation
While the overview above should give you a good sense of the main factors to keep in mind when discussing implant options with your surgeon, we understand that plastic surgery consultations can be overwhelming. Coming ready with a list of questions is a failsafe way to ensure you get the information you will ultimately need to make an educated decision. A few questions you should consider asking about breast implants include:
1. Which type of implants do you usually use and why?
This inquiry will kick start a conversation about the material used to make the implant, the look and feel, the longevity, and more. You can use this opportunity to share more about your lifestyle and your personal aesthetic goals, both of which will factor into your final choice. At this point, you will likely also be able to hold a few different types, so you can start to — quite literally — get a feel for the implants. “There are pros and cons to each type of implant,” Dr. Chmielewski says. “I discuss each with my patients, and we arrive at a decision that works for them.”
2. What size implant would you recommend for my body?
This question gives you the chance to start discussing what is possible from a size perspective taking your preferences and anatomy into account. “I do a breast exam where I take careful measurements of all breast dimensions and note asymmetries,” Dr. Mahmood explains. From there, she reviews the three implant-based factors — shape, projection, and volume — with her patients. “Based on their breast measurements as well as their desired result, the patient and I work together to select the best implant for them,” she shares.
On the topic of symmetry, Dr. Mahmood is quick to note that body asymmetries are the rule, not the exception. “I always tell patients: Breasts are sisters, not twins,” she says. “Asymmetry is common.” So while breast implants can help to address asymmetry, the purpose of the procedure is not to make your breasts identical.
3. Should I expect to have any revision surgeries in the future?
While modern silicone breast implants may not need to be replaced at the same rate as older models, breast augmentation is still not a one-and-done procedure. There are, however, steps that can be taken to prolong the life of the implant. “I believe that getting the desired result with the least amount of volume possible is always the goal,” Dr. Unger shares. “This allows you to have long-lasting, stable, and beautiful results.”
This also means not placing implants beyond the boundaries of the anatomy. For example, consider patients who get, in Dr. Unger’s words, very large implants placed into very small chests. “It might give them the fuller look they want,” he says. “[But] the problem is that, over time, it places excessive amounts of tension and stress on the breast and causes tissue to stretch more quickly.” This can lead to a “droopy or ptotic shape much more quickly,” he adds.
Choosing breast implants is a hugely important (and personal!) step in the process of preparing for a breast augmentation. Your plastic surgeon will be there to guide you through the decision and offer a range of methods to figure out the right solution for your needs. It should come as no surprise then that many patients find the key to a successful outcome is finding a plastic surgeon who truly understands the results they’re seeking and how to achieve them in a safe and natural-looking way.
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