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My approach to selecting a size for one's breast augmentation is that it is the patient's choice. It is not for me to judge someone's taste or desires. Breast size is a very personal issue and it is, to some degree, a bit like art. Beauty (breast size) is in the eye of the beholder. My goal is to make the patient happy. I usually do this by asking the patient to show me pictures of what size they think looks good and then I try and match that size concept in the surgery. The only preoperative measurement that carries much weight to me is the base diameter of the patient's breast. I have found few women want a breast implant that goes too far to the side and gets in the way of arm movement. Therefore, I keep the size to no greater than the existing breast base width. If the size is going to exceed the breast base width, that is one good reason to go with a high projecting breast implant so that one's breast volume comes forward and less to the side.
In the majority of breast augmentation in my practice, I find that most women select sizes that would be viewed as 'reasonable'. That breast implant size range seems to be between 300cc - 450cc for about 85% of my patients. The remaining 10 - 15% of my patients are anywhere from 450 - 700ccs. For a larger women, in both height and weight, these breast implant sizes are still 'reasonable'. For smaller women, these sizes would be considered quite large.
While, on the one hand, it is not my concern when a patient opts for a very large breast implant, I always feel compelled to make them aware that there are some long-term consequences to that choice that they need to be aware of. First and foremost, it is easy to increase the size of the breast but it is difficult to go the other way. Going down in size later may mean the need to do skin reduction and create scarring to maintain a good breast shape. Secondly, the larger the implant, the more loss over time the patient will have of their remaining breast tissue, otherwise known as pressure atrophy. In many large breast implants over time, the patient will only be left with skin and an implant with little breast tissue in between. Lastly, the weight of a very large breast implant over time may cause the entire breast to sag, weakening the skin support of the breast under its own weight.
Patients who choose large breast implants also need to appreciate that a woman's perception and goals of her breasts will change throughout her life. Like that tattoo of 'Bill' put on your arm at twenty, you may not even know Bill by the time you are forty.
Dr Barry Eppley is a board-certified plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com
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