The first thing that must be clearly understood is that even without an implant, you can expect your breasts to get smaller with age and weight loss. Unless something is specifically causing breast enlargement, like hormones or weight gain, nearly always breasts get smaller with age. Because breasts usually get smaller on their own, you have to assume that having implants will not prevent your breasts from shrinking with age. The amount of age-related shrinking cannot be predicted.
In addition, there is some decrease in size due to the mechanical pressure exerted by the presence of an implant. This factor is taken into account when the surgeon calculates what size implant it will take to bring you to the size you showed him/her you want, but can never be predicted completely.
Another important cause of size change is weight change: weight loss makes breasts smaller. It is crucial that every breast implant patient understand that even a few pounds weight loss will likely decrease the breast size a noticeable amount. It is not unusual for a 10 lb. weight loss to decrease the breast size by one full cup size. Remember that a decrease in breast volume will cause a more defined look and may make it easier to see or feel any rippling of the implant.
Another factor to consider is that there will be temporary swelling right after the operation. It is all too easy for a woman to get used to that swollen size, even though it is larger that what she initially wanted. Then, when the swelling goes down, she notices it and may wish she were still the swollen size.
And a final, very frequent, phenomenon is that the woman simply gets used to the new large size very quickly, and then it doesn't seem so big anymore. The size that she may have thought looked so large when she tried it out in the office before operation, doesn't seem so large once she gets accustomed to it later.
Because of all these factors, we advise patients to be certain that they are choosing a large enough size in the first place. A significant percentage of women decide later that they want to go through surgery again to be a larger size than they had initially wanted to be. (The other way around - where the patient returns for repeat surgery to go to a smaller size - is quite rare) It is important to be aware that going larger later is usually a more expensive operation than having the implants put in the first time.
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