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What's your implant size?


  This might be the question for what I get the most astonishing answers (mostly due to false expectations) day by day when I am consulting, although I never put this question for my patients. It will be clear by the end of this page that they do not have to answer this to get the aesthetic and anatomically ideal implant matching her expectations. If the patient would know the answer, she were the plastic surgeon and I were the patient. Let’s see some ideas about breast implant sizes which I have already heard in my office, some of them quite often:

„As big as it can be!!!”

„Big enough to lift my drooping breasts” (not possible!)

„As small as possible! (so my mother-in-law, my boss, my colleagues would not suspect anything)” – This means that she would like to have the operations, but she is also afraid of it. This is the patient who usually wants bigger breasts already 2 months after the operation.

„I want 270 cc implants, because my friend or colleague has this size, and I like it! (How big were the breasts before??? I don’t know! How broad is her chest??? I don’t understand!!!)”

„I want them pretty big, and I want to deflate them when I am not at home, because I’ve heard that there are adjustable size implants with valves!” – (The husband of a patient told this and I never operated the wife, since she didn’t even want the operation and didn’t answer any of my questions, the husband simply dragged her to my office for a breast augmentation.)

To select the desired and optimal implant size for any given patient is the result of a communication process, the consultation, and the final result is the volume of the implant. The key steps are the determination of the implant diameter and height. The third component to calculate the volume would be the ¶ factor (in the required formula) as we know of geometry, but we do not have to use it because it is integrated in any implant size chart.

The first question to discuss in front of the mirror and/or looking at pictures, before & after photos is:
Where shall be the inner contour/border of the breast after the augmentation? (this can be demonstrated with a manoeuvre before the mirror) This will determine the border of the implant placement on the inside. (the thickness of the patient’s tissues also must be considered)

 

  Determining the desired inner fullness of the breast


The next question which the patient has to answer looking at herself in the mirror or looking at before & after photos is:
How far shall the contour of the enlarged breast laterally exceed (or shall not exceed – but only 5% of the patients say so) the projection of the chest wall? (this can be demonstrated also with a manoeuvre before the mirror) This gives the outer border of the implant. (counting also the patient’s tissue thickness into it)

 

Determining the desired outer fullness of the breast

 
The distance between the two borders gives the ideal implant diameter matching the individual chest conditions and the expectations of the patient, which she can easily control before the mirror. We only need a ruler or a tape-measure for this.
 
 

The desired implant width (diameter)


A more difficult question which the patient can often decide only after looking at lots of before & after photos is:
What kind of an upper contour (fullness) would she like to have, looking at the breast sideways (between the areola and the collar-bone)? Straight? Bulging? If bulging, how much? (this can be demonstrated with a manoeuvre before the mirror, unless the patient has very small breasts, or can be determined by looking at photos)

This determines the required implant height (projection or profile).

 

Determining the desired upper fullness of the breast


When the plastic surgeon makes his suggestion for placing the implant under or above the muscle for the given patient, he must know what implant profile (how “flat” or “bulging”) can give the desired upper fullness - based upon his experiences. It is a question of confidence for the patient to believe, that the plastic surgeon knows what implant profile to choose to get the desired breast projection.

 
 

The profile (height) of the implant and the thickness of the tissue above (which is different when placing the implant under or above the muscle) together will give the expected upper fullness of the breast. At submuscular placement the extent of the upper fullness using identical implant profiles depends on the thickness of the muscle and the glandular tissue, which are individual characteristics.


Using the determined implant diameter and profile height in the charts of implant manufacturers these will give the volume, namely the size of the implant at any brand and model. Our method unifies the selection criteria regarding anatomical conditions and individual aesthetic expectations. Individual characteristics and conditions might modify this in order to reduce risks.

 
 

The determined implant diameter and profile height give the volume


Using different size implants for patients with different glandular tissue volumes (and pectoral muscle thickness) the same breast size can be created. That’s why the often heard wish doesn’t make any sense: “I also want 325 cc implants, because my friend got beautiful breasts with them”. In such a case, when we ask what were these breasts like before the operation, or does she know what were the glandular tissue and muscle conditions, the answer is usually “no”.
 
 
 

Different profile height implants of the same brand


The breast size (and shape) after the augmentation is not only the product of the implant size (and shape), but also depends on the volume (and shape) of the glandular tissue and on the thickness of the pectoral muscle at submuscular placement, it is a combined effect.

Therefore, it is not worth to ask the patient about cubic centimeters, milliliters or grams, but about what she would like to have here, there or anywhere. It is not worth operating the patient until she can’t give the proper answers to these questions and she doesn’t understand this. The plastic surgeon, who tells the patient that the implant size will be clear only during the operation and she should simply trust him with this, has no routine at planning. The plastic surgeon, who doesn’t ask the patient about her clear aesthetic expectations regarding the upper fullness and inner-outer contours of the breasts, can not communicate and there is only a small chance that the patient will like the result.

It can happen at asymmetries or at rare individual conditions (which can be estimated before the operation), that the previously determined volume must be modified a little (with one size) during the surgery, but this must be told in advance for the patient.


According to the above, the conditions for determining the ideal size implant in every respect are:

- a thorough, considered, detailed consultation before the mirror and looking at
   before & after photos
- the patient must know what she wants on the top, on the inside and outside of her
   breast; namely she should look at numerous photos before the consultation,
   and she should be able to consider these details as independent factors
- the cooperation of the patient and the plastic surgeon
- a measuring tape (as the smallest investment) in the hand of the plastic surgeon
- looking at the implant charts together
 
 
 

Chart of different implant profiles used most frequently in the New Contour Plastic Surgery, we marked the practically used average sizes in our practice (based upon the average of the last few thousands of patients)


After all, regarding the individually calculated and suggested implant size and shape, the patient shouldn’t let herself be influenced by relatives, friends or anybody who is not a plastic surgeon!

If the breasts are somewhat different in size, it is possible to correct the difference in a breast augmentation operation using implants which are different in size and scale; for bigger volume differences the postoperatively adjustable size double chamber implants can be used. If the volume difference of the breasts has disturbed the patient before the operation even to the smallest extent, it will certainly disturb her more afterwards without its correction. The augmentation of different size (volume) breasts with identical volume implants will result in different breast size, creating asymmetry and dissatisfaction.

 
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