Choosing the right breast implant – 2010 edition

This is an update of a classic blog from 2008 – but the information I wrote then is still relevant to selecting the right breast implant size & shape, which is one of the most important factors in getting a nice result, and a happy patient!


Breast augmentation is the most popular procedure in our practice (ed: still is now in 2010, too!)- we help several hundred women with this each year. In order to have a happy patient, one of the most important choices we make together is figuring out exactly the right size for the implant. The three of us – the patient, my nurse and I work together on this, until we’ve found “just the right one”.

Many of my patients request something that looks “proportional” for their frame. Most of them want something in the mid-C to small-D cup size. Some want more, some want less. We try to give the patients “what they want”, as much as possible.

In the old days, implants were chosen strictly by their volume – if you wanted to be 2 cup sizes bigger, you needed a 300-400 cc implant. Unfortunately, that calculation didn’t take into account the patient’s height, size of their ribcage, or other parameters that vary widely from one person to another. With this old fashioned method, some implants would be too wide – making the patient look heavy; some implants would be too narrow, leaving a big gap in the cleavage area. Not optimal.

I think the key factor is to get the implant width right. After all, most women who are signing up for breast surgery want a nice cleavage – and want to avoid a big gap in the center. Most augmentation patients also want to fill up the width of the breast nicely, but avoid looking excessively broad in the chest, with the implant being so wide that it ends up sticking way out the sides, under their armpits. Most patients want to stay “slim and trim” when it comes to the side of their ribcage.

While other doctors may have different opinions, here’s a quick summary of what I do:

1) Start by measuring the width of each breast with a tape measure – going straight across from the inside of the breast (near the cleavage) to the outside of the breast. This will give you a number which varies from 11-12 cm in a petite patient, to 15-16 cm in someone with broad shoulders.

2) Next, measure the thickness of the patient’s own tissue. This can be done by measuring the “pinch thickness” of the breast laterally. Subtract this number from the width number.

3) Now that we’ve determined the approximate “base width” – the footprint – of the implant, we can have the patient try on implants of this particular diameter in a sports bra and T-shirt, and see what she likes in the mirror. We know that these implants are going to be a nice proportional size for the patient’s frame, which makes a good place to start our discussion. We make adjustments from there, depending on the patient’s wishes…

Of course, the look of the implant in the sports bra isn’t 100% identical to what we’re going to see post-operatively, but it is a pretty good approximation of the size and weight, and it’s probably more accurate than most computer imaging software is at the present time.

This try-on process takes a good bit of time with the patient, so that’s the reason that many other surgeons don’t do it – but it really makes a huge difference in the quality of the results and in overall patient satisfaction.

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