As breast augmentation continues to evolve, many patients opt for larger implants, although there has been a preference shift towards more natural-looking results. One of the recognized problems with large breast implants is that they can bottom out over time. This is due to a mismatch between the size and weight of the implant and what one’s breast tissue can support. Therefore, contemporary theory of breast implant sizing is that the device selection should not substantially weaken the soft tissue and ligament support of the breast. This approach will occasionally put at odds what a patient wants and what the plastic surgeon may recommend.
While many women have a specific breast size in mind that suits their body type and often worry about them being too large after a breast augmentation, some women prefer a significantly larger size. Under these circumstances, the plastic surgeon may be caught between what he/she thinks is a good size and what the patient really wants. One could argue that the patient does know best in terms of their desired breast size, but they may not have a good understanding of the potential long-term implications of their choice. The goal, of course, is to make the patient happy; but one also wants to reduce the potential for revision surgery in the future, which is not rare in breast augmentation.
So, what is a good implant size choice? How big should one safely go? Plastic surgeons will differ in their approach, but a good rule is to not have the base width of a breast implant exceed that of one’s natural breast. All breast implants have a width at their bottom, when laying on a table, that gets wider as the implant volume gets bigger. If the implant starts to get wider than the chest wall or breast, it will get into one’s axillary space and get in the way of the swing of the arm. Also, a breast implant that gets too far to the side makes recovery from this problem very difficult. When this occurs, it makes downsizing an implant and later closing or tightening the pocket very difficult.
The consideration of the base width of one’s breast is one of the primary reasons for having different projections or profiles on the implants. Projection is a design consideration of an implant that changes the height: width ratio but keeps the same volume. Three different projections are available for every saline breast implant size, and five projection options are available for gels. If the size a patient wants is a little too wide, then a narrower width implant with more forward projection can be used to achieve the same volume or size (otherwise known as a high projecting or “high profile” implant).
Larger breast implants may be acceptable if their widths do not exceed the natural base width of the breast. In the end, breast augmentation satisfaction is ultimately a combination of the final size and shape that is achieved, along with realistic expectations of the outcome. If you are ever unsure, we encourage you to reach out to your plastic surgeon to discuss further! The goal is that you feel comfortable and confident in your decision prior to proceeding with your surgery.
