Once a patient has demonstrated to me what their ideal breast appearance is (by picking their favorite patient photos on my website), I check to make sure that the photos they selected are relatively realistic comparisons for that given patient. If the comparison is fairly unrealistic, I will keep the “ideal” in mind, but also direct them to more realistic comparison photos. Everyone has unique features to their breasts that will carry over to their result after breast augmentation, but seeing a patient’s ideal certainly helps me focus in on their preferences with regard to size, proportion, upper breast fullness, breast width and cleavage.

I also generally ask my breast augmentation patients in Phoenix whether they are more worried about being too big or too small, so I will know which way to lean once I am within their target size range. Most patients prefer to lean towards the somewhat fuller side of their preference range; however some patients are much more interested in maintaining a smaller overall breast size.

In addition to a patient’s desires, it is also important to match an implant appropriately to their tissue parameters. In other words, the implants must fit the proper width of their breasts and not exceed the capacity of the tissues and skin to support the implants. This is where my judgment and experience as a surgeon come in, and I guide patients to a choice that will both meet their initial goals and hold up well over time.

When I am in the operating room, I create the appropriate sized breast pockets in each patient, taking care to maintain as natural and smooth a space for the implants as possible. After the first pocket is created, I place a sizer (which is a replica of the final implant) into the patient’s breast pocket. Which size and profile sizer I pick initially will be based on the patient’s preoperative size and shape wishes, their tissue parameters, and my experience to give them the best overall result. Once the sizer is in place, I examine the patient both lying down and with the operating table in the seated position (with the patient still asleep) in order to assess the implants size, position and contour. I will then try some other sizers while comparing the patient to their preselected photos to ensure that the final implant choice is the best I can provide for that patient.

Since I have my own operating room, I have a full range of implant shapes and profiles with the corresponding sizers, so I never have to guess whether an implant will look right. I can see exactly how it looks using the sizer before I open the final implant. Once I finish sizing one breast, I do the same for the opposite breast to ensure the best possible symmetry. Many surgeons don’t use sizers, because it does add some time to the surgery. For me, the extra time is worth it for a more aesthetic and precise result. As I explain to patients: you probably wouldn’t buy a pair of shoes without trying them on, so if I am placing implants in your body for potentially 10 to 15 years, I like to test it out the fit on them too!

Deciding proper implant size is one of the more challenging aspects of breast augmentation in the Phoenix area for many patients and surgeons. Patients are often surprised to find out that the relationship between implant size and final breast appearance can be quite complex.

The first thing patients need to understand is that the term cc (cubic centimeter) simply refers to volume. To convert this from the metric system into ounces, 1 ounce equals approximately 30 ccs. In other words, a 300cc implant has a total volume of 300 cubic centimeters or approximately 10 ounces.

How this volume impacts a given patient depends on many factors. For example, when patients ask how many ccs make a given cup size, I answer their question with another question: how far can you drive on a gallon of gas? They usually pause and say: “it depends on which car I’m driving.” Clearly one can drive a lot farther on one gallon of gas in a Prius than in a Hummer. Likewise, a 300cc implant will look a lot bigger on someone who is 5’1″ and 100 pounds than it will look in someone who is 5’10″ and 175 pounds.

Another factor that determines the final result is your pre-existing breast tissue. Some patients start off with a lot more breast tissue than others. The final breast volume is made up of both the natural breast volume and the implant volume. In other words, Preexisting Breast Volume + Implant Volume = Final Breast Volume, so the less natural breast tissue you have, the more implant you will need to reach a given volume.

Another consideration is the elasticity of the tissues, or how much the skin stretches. Patients with very tight, thick tissues will tend to compress the implant more, making it look smaller. Patients with looser tissues will stretch more, allowing the implant to look larger.

There are certainly many other considerations I make when deciding on an implant size, such as breast width, ribcage shape, asymmetry, etc. All of these variables affect final breast appearance. This is why two patients who have a similar final appearance may have very different sized implants. This is also why I feel it is easier for a patient to choose a desired “look” than to choose an implant size. It’s hard for an experienced surgeon to know exactly how a particular implant will look in a given patient, so imagine how difficult it would be for patients to select their own size! I’ll explain more about how I make my implant choices soon in part 2 of this discussion.