This is a 37 year old mom, 5’3″ and 135 pounds who had a previous breast augmentation performed elsewhere. She told me that she didn’t think her breasts were big enough. Her implants were silicone 225cc bilaterally and placed above the muscle (subglandular). On examination of her breasts, they were relatively soft and symmetrical. Nothing, per se, was abnormal. However, on further analysis her breast implants appeared somewhat “stuck on” in appearance (she described them as looking like Christmas ornaments). Her breasts also appeared quite round as her implants were above the muscle and they were not big enough to fill out her chest and appear natural.
I performed a breast revision, removed her implants and replaced them with moderate profile silicone implants, 350cc in volume, and put them below the muscle. You can clearly see that they “fit” her better. Submuscular placement of the implant resulted in a more natural slope of the upper breast and a better feeling breast. In her case, larger is better as they are more proportional and look more natural, less “stuck on.” A larger implant is also more appropriate in her chest wall contour as much of the volume of the implant is used just to fill in the “low” areas of her chest. As much as I encourage moderation of implant size, this is a rare case of “should have gone larger.”
Choosing the right style implant and correct implant size is a very critical component of a successful outcome, yet plastic surgeons use very different techniques. Some surgeons use measurements to determine breast size. This method is good if you don’t have the experience to simply “eyeball” the best fit. Various alternatives include computer imaging, sizing in the operating room, asking what size a patient prefers, bringing in photos that you would like to be, using what a girlfriend who’s already had a breast enhancement selected, and trying on sizers before surgery to see what works best.
In my opinion, the best alternative is the last. Seeing for yourself what your breasts would look like in the mirror, accompanied with feedback from your surgeon, is about as foolproof as it gets.
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