Breast enlargement surgery continues to be one of the most popular cosmetic plastic surgeries that any plastic surgeon can perform.  Augmentation of the breasts with either saline implants or silicone implants allows patients to achieve an improvement in their body proportions. Secondarily, breast enlargement surgery gives a great deal of self-confidence to women with smaller breasts in a society that places value on a larger breast size.

Choosing the correct size

Every plastic surgeon has his or her own method for determining the best size of breast implants for the cosmetic patient. Some plastic surgeons arrive at the surgery with an array of different breast implants and use implant sizers during the surgery to determine the best size in their opinion. I prefer to let the patient do that before the surgery. The actual time spent in the operating room should be kept to the minimum necessary for the procedure and not for artistic musings by an ill-prepared surgeon (!). On the first consultation with a plastic surgery patient interested in cosmetic breast augmentation, I like to have them actually try to see a semblance of their probable outcome by placing silicone implants on top of their breasts while wearing a sports bra or any other type of bra without padding. In my 20 years of breast augmentation surgery experience, this has provided me and my patients with the best approximation of what they would look like with larger breasts.

Measurements for correct implant sizing

I use certain relationships as guidelines for choosing the best breast implant size. Apart from the height and weight of my patients, I measure:

  • chest circumference under the armpit
  • chest circumference under the breast
  • bust size at the nipple
  • width of the hips
By placing a silicone or saline implant into the bra of the patient wearing a tight T-shirt, the cosmetic patient can see for themselves what they will look like after the surgery. Yes, there are some expensive, time-consuming and generally useless photography-based software programs that will give a simulated approximation, but I believe there is nothing like seeing yourself in the mirror.

How to choose breast implants

I have developed some basic guidelines over the years to help my patients choose the best implant size.
  • Keep bust size smaller than hip size; a larger bust makes the patient look top-heavy and likely to fall over in a strong wind.
  • I tell patients not to cheat themselves out of the surgery by choosing a breast implant that is too small or that won’t let them see a difference in breast size.
  • Choosing an implant size that is too large will make the patient look fat.
  • Patients who have a wide chest and broad shoulders will need larger implants, narrow-chested patients smaller ones.
  • Patients with thin skin and less fat need smaller implants, and silicone implants may be preferable.
  • Patients who have little difference between their hip and chest widths may need “high-profile implants.”
  • Tall patients need larger implants.
  • Short patients need smaller implants.
  • Stay away from “contoured implants”; they are nothing but trouble.
  • I point out the differences in breast size and shape between breasts before the surgery; breast augmentation will make breasts larger but won’t change the innate shape of the breasts; saline implants may be necessary for differential fill volumes between breasts if there are large differences between the breasts’ sizes.

Once the patient has tried out the implants and chosen a size, I tell them to go home and fill zip-lock bags with rice (water gets too messy) of a volume similar to the implants they like and try the same exercise at home with different clothes. Your look in a bikini will be different than in a big sweater.

Of course, when the patient comes back to set up surgery, we do it all over again. 95% of the time we choose the correct breast implant at the first consultation!

For a more mathematical methodology, look at this previous post:

Which breast implant size do I need- mathematical model

Morad Tavallali, M.D., FACS