Why Is Choosing the Proper Size So Important?
Good, Quick and Cheap: You can have two but not all three...
If you ever dealt with a contractor, you know you want work done quickly, you want it done well and you want to pay as little as you possibly can for the work. This is only human nature. Most contractors will tell you that you can have any two, but that it is impossible to have all three. In the world of breast augmentation, many women want to go large, but they want to still look natural. The fact of the matter is that once you start exceeding the natural limits of the breast tissue, distortion of contour arises along with other issues that can result in potentially uncorrectable problems.
It cannot be emphasized strongly enough that if you want the best possible looking breast with the easiest recovery and the least chance of problems leading to re-operation, then selection of implant profile and size must be in accordance with the characteristics of your tissues. Any attempt to force your tissues to bear a size and/or shape that are beyond the limits of your tissues will be accompanied by an increased risk of tissue damage such as breast tissue atrophy and overstretching, and the creation of potentially uncorrectable deformities. Despite what anyone, including another plastic surgeon, might tell you to the contrary, this is true whether I or any other surgeon performs your surgery.
When I measure your tissues, I will determine what I believe under the circumstances to be the most ideal size (in cc’s, which is a standard measurement, not cup size which is nebulous and not standardized) implant for your breasts. It may be that this number is very similar to that of an available size implant. If that is the case, then that size implant is the best size for you. If the optimal size determined by me falls between the size of two available implants, then most likely, you can achieve a similarly good result with either size implant as the difference in volume of either implant from your ideal volume is relatively small.
I am occasionally asked if I will use a volume other than what I feel to be the best for your breast tissues. If I use an implant smaller than what I measure, the potential untoward effect is usually just cosmetic in nature; the implant may not look large enough for your breast. Usually I can drop down one or two implant (not cup) sizes without too much of a problem. However, if I am asked to use a larger implant that I feel is optimal for your tissues, the situation is very different. If I believe that the size requested is so large that I have to worry that the wound may break apart, or that I will do severe damage to your tissues, or will produce a result that is not what you are requesting (especially if you want a natural result) than I will not proceed using that size implant. If I feel that your breast will accommodate the requested size implant, but that there may be more of a risk of numbness, pain, longer recovery, overstretching of the lower part of the breast (usually more of an issue in women who have not had children or have a tighter breast tissue envelope), then I will agree to proceed, but you will be advised about those increased risks.
Do I lose cases at consultation because I cannot (or will not) produce certain results as requested by the patient? I am sure I do, but I know in my heart that I am following my duty to advise the patient appropriately and to not perform any surgical procedure that I believe is not in the patient's best interests. Looking at it the other way, in my practice, using the thoughts and processes as discussed on this web site, it is extremely rare for me to perform a breast augmentation only to have the woman dissatisfied with the size and request a revision to a larger size.