Despite all the time that most cosmetic plastic surgeons spend, or should spend, with their breast augmentation patients to find the correct breast implant size, sometimes it’s just not what the patient wanted.

I should preface this little discourse by stating that over 95% of patients who want a change in their breast implant size want to go bigger. There is only a handful of patients I can remember in the 20 years I have been in practice who thought their implants were too big and wanted smaller breast implants or no implants at all!

Choosing the right breast implant size for augmentation

I have previously discussed the factors that your plastic surgeon must take into account when thinking of breast enlergement surgery with implants. These include:

  • Height and weight
  • Hip and chest circumference
  • Droopiness of breasts
  • Cultural factors
  • Patient wishes (of course)
I always have the patient try the proposed implants in the office by placing a silicone implant in a sports bra. In my hand, that gives me a pretty good idea of the right size. I have a little fudge factor I add in, and if there is any doubt I recommend going one size larger.

Waiting for breast implants to settle down

All breast implants initially “ride high.” Because I place my implants under the muscle, both the muscle and skin must stretch to allow the implants to fall into the correct position. This process can take four months or more.
It is not unusual for a patient to have great ambivalence about their implant size. The breasts may initially look too small, then too big and then a Goldilocks just right as the patient’s brain learns to accept the new breasts and the change in their body image. Still, if a patient wishes to go larger or smaller, I recommend they wait at least six months after the surgery. In my plastic surgery practice, that turns out to be one or two patients a year.

Breast implant exchange surgery

The funny thing is that the actual changing out of a breast implant after breast enlargement surgery is rather easy! The initial surgery for breast augmentation must be performed under general anesthesia, but the implant exchange surgery can be done under local anesthesia in the office. The pocket where the implant sits has already been formed and the skin and muscle already stretched. A small incision is made, the implants are removed (by bursting them if they are saline) and the new breast implants are placed into the same pocket in a sterile fashion. Patients typically return to work the next day! This is a case in which the actual surgery is much easier than the anxious waiting that must by necessity prevail.