Answers to Frequently Asked Questions about
breast enlargement:

How is the correct implant size determined?

It is also essential to understand that the implant represents the difference between what you start with and where you want to end up. An obvious example is this: say I have a drinking glass that holds 8 ounces, and say that it already has some water in it but I'm not revealing how much is already in it. If I ask you how much water will it take to bring it up to 8 ounces, you would say that you cant answer that without knowing exactly how much is in the glass to start with. It is the same with the breast implant size choice: it depends on exactly what you are starting with! So, how do we decide the volume needed?

First, how NOT to determine the implant size:

• not by comparison to your friends - their body shape, chest size, skin thickness, and breast size are not likely to match yours exactly!
• not by letting the surgeon decide - each surgeon has his/her own preferences for the size they like, which may be quite different from what you want. Some surgeons even refuse to use an implant over a specific volume!
• not by stuffing different sizes of implant inside the bra - to measure the differential volume between the breast and the desired bra size, standard pre-filled implants have the wrong shape and give the wrong volume!
• not by formulas and charts - these cannot take into account the specifics of how your chest shape and rib cage will make you look!
• not by using famous models/actresses/singers implant sizes as your guide - how do you know what their breasts and chests looked like before their operation?
• not by computer simulation - computers cannot yet predict how you will heal, and though they are great for noses and faces, they are not very helpful for breasts!
• not by leaving it until you are in surgery - you deserve to know in advance what your size will look like when you wake up, not get surprised!
• not by looking at pictures of someone else - pictures are very helpful to the surgeon in getting to understand your thoughts about shape and proportion, but pictures are a very poor way to decide on implant size.

It is all too easy to get hung up on discussions with other women about cc's and ounces. There is a way to determine the correct size of implant for you, and even to see exactly what you look like with that size, in the clothes you like to wear! The whole point of augmentation is the final appearance, not just a number. So the secret is to focus on showing your plastic surgeon the proportion you want, using your own body to demonstrate.

Here's how we go about it in my office:

The first step is the most difficult: you have to decide what size bra you want your new size to be. Start by trying on different sizes of non-elastic bras in the store (remember that the band number will not be changed by surgery, only the cup letter), filling the bra with cotton or other padding material, until you see the proportion that is right for you. Also remember that not all manufacturers use the same measurements for a given size - that is, not all 34C bras are the same size. So just find the particular one that you look best in! Buy that bra. (There is certainly nothing wrong with experimenting at home with the "Rice-in-the-Ziploc" method at this point; but there is no point to getting bogged down with the question of how many cc's.) Then bring that bra to the office, along with any photographs that you feel illustrate aspects of the appearance that are important to you. There, using that same bra, we will put a selected adjustable water-filled insert into the bra, and fill it until it just fills out the bra you chose, making up for the difference from what you started with. Next, we measure your breast and chest dimensions, particularly the diameter of the base of the breast, but also taking into account other distances, such as from the nipple to the crease underneath. Then, after measuring the volume of the insert and its contents, and adding in factors for the implant shape and position you chose, we run a set of complex calculations to translate that into the implant size that will produce that effect for you. Then, and only then, does the number of cc's enter into the picture. This "dimensional" approach allows us to accurately determine the proper implant for meeting your needs.

One other piece of information that it may be helpful to know when trying on bras before or after operation. The breast that fits a bra of a specific band-number and cup-letter will not fit the same cup-letter in a different band-number; for example, if your breast perfectly fits a 34B, if you buy a 32 or a 36 it cannot be a B. That is, a 34B breast is the same size as a 32C breast is the same size as a 36A breast. These do not LOOK the same proportion, but that's the way the measurements run. So, for example, let's say you can wear either a 32 or a 34, just adjusting the strap tension differently. Well, if you fit a 32C, then if you put on a 34C it will be too big in the cup, and you should wear a 34B. We often hear women ask "what size implant should I get to be a D?" Why can that question not be answered without examining and testing the woman? First, we would need to know what the band-number is - a 38D breast is much larger than a 32D breast. Second, we need to know the current breast size exactly. Third we need to know if the implant will be over the muscle or under the muscle. Fourth we need to know whether the implant will be round or contoured. These are all important.

Of course, there are some patients who decide later on that they would like to move up to a larger size than they originally wanted, but they had indeed gotten the size they had initially wanted. Many plastic surgeons use a similar technique - and more should - so that the woman does not have to be surprised when she wakes up and sees herself after the operation.

It is good to trust the doctors to do their best for you; but it is not good to leave questions of your personal preference and taste up to them, nor to leave this important decision until you are "on the table".

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