By Lawrence N. Gray, MD
Board Certified Plastic Surgeon since 1985 Atlantic Plastic Surgery Center Portsmouth, New Hampshire

The process of choosing a breast implant size that will look right for you takes careful planning and collaboration with your surgeon to produce results you will be very satisfied with. You want to make the right choice, the first time. You want to achieve an improved breast line and a balanced, pleasing, natural-looking body form without the risk or expense of a secondary surgery. I am fortunate to say that, due to my 25 years of experience, the vast majority of my patients are very happy with their results after surgery. But, nationwide, it is reported that a full third of patients nationwide choose to have a second operation to change the implant size. Here?s how that can be avoided.

Two common questions women who are seeking breast augmentation ask are: “What will I look like?” and “How will different sizes will look on me?” Many are concerned that the size they choose will be too large and will look unnatural and that they will feel awkward in front of people they know. Pre-planning with your surgeon will go a long way toward ensuring that when your breast augmentation experience is complete, you’ll be happy with the results and feel very comfortable with your appearance.

First, it is important to choose an experienced, board-certified plastic surgeon specializing in breast augmentation to help you decide how much larger you want to be than your current breast size. A boarded certified plastic surgeon can evaluate your anatomy and take accurate measurements of your chest and breasts to determine the proper proportions for your frame as well as take into consideration how loose your skin is. You must have enough tissue to cover the breast implants for an aesthetically pleasing augmentation.

Most women want to make sure they will look natural, but improved. My staff and I take the patient through the size selection process carefully so she will end up being satisfied how she will look after surgery. I have found the Axis 3D breast augmentation simulator to be an enormously helpful tool for assisting a patient in selecting the best implant size for her body. You will be able to see your own body with varying implant sizes. We can show you an actual visual image of yourself in 3 dimensional form, simulating the “before and after”. We work with you to explore just the right implant in size and shape that compliments your own body.

The breast augmentation simulator allows greater guidance and direction for more accurate customization, placement and shaping of the implants. It is especially helpful if a woman has asymmetrical breasts. The visualization also helps you see the desired outcome from all angles – side and front – before the procedure is performed and to make any necessary adjustments, which is a very important aid. The simulation is also helpful for a woman to understand if breast implants alone would correct sagging skin or if she may need a breast lift. I perform augmentation using both saline and silicone implants. Fitting the right size implants to a woman is the same process for both saline and silicone. The imager helps with both types of implants.

Is bigger better? Not necessarily. Patients have often been advised by other surgeons to “go larger”, because it is a common statement made: “I wish I had gone larger”. It is my opinion that the larger you go, the more you risk an unnatural look. Also, larger implants are often too wide for a smaller body. I feel that it is better to have as accurate a prediction process ahead of time as possible. With the Axis 3D simulator, you are much more likely to choose the size that is right for your body the first time around- not too small, not too large. Implants that are too large not only will upset the aesthetic balance of your figure, they also may be more prone to sagging and ultimately give you a “matronly” look. Many patients mistakenly think that larger implants will correct sagging. The imager helps to visually demonstrate that if a patient needs a lift, no implant alone will substitute for a lift.

The American Society for Aesthetic Plastic Surgery (ASAPS) offers helpful tips to women trying to make this decision with which I heartily agree with and pass along to my patients: Communication is key! Be frank and open in discussing size. Select several photographs from magazines illustrating your ideal proportions, and bring these to your consultation. Be as specific as possible about what you like about them, but realize that your own “after” pictures will reflect your desires and who you are. Bring examples of individuals with a similar body type to yours. Don?t define your desired size only in terms of bra-cup size. Cup size can vary significantly among bra styles and manufacturers. Maintain realistic objectives. The best approach is to select implants that will look like a natural part of your body. Ask to see before & after pictures, not only to judge your surgeon’s work, but, to get an idea of what size implant you will need. Obviously, the breast size you start with will influence the implant size you choose. If you start as an A cup, you’ll need more volume to take you to a C cup than a woman who starts as a B cup. I have actual breast implants that you can try on during your visit, in addition to using the 3D imager, if you so choose. It’s important to note that volume refers to size, not breast shape. Breasts that have sagged over time may need a breast lift in addition to augmentation to achieve the look you want.

After you’ve presented your goals, listen to what your surgeon has to say. If my professional and experienced opinion is that your selection is too big for your frame, I hope you will listen to why I may feel that way. Or I may be able to offer the opinion that you could go larger and still get excellent results. The Axis 3D can demonstrate the “why” in either case. Your consultation should be a give-and-take arrangement that’s open and honest so that can agree on the best outcome available.

The process of deciding the right breast implant size for you is layered with important choices and considerations. The right breast size depends on your individual taste, your body frame and type, and the “look” you’re going for. Choose a size that makes you happy, not your spouse, significant other or friend. You’re the one who will be living with this decision. The professional opinion of a board-certified plastic surgeon who’s experienced in breast augmentation, coupled with realistic expectations on your part, can help ensure that you’ll end up with the bust line you’ve always wanted.

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