Width, amount of existing breast tissue and desired projection determine style and size of implants. No guarantee is made of end result sizes. All bras fit differently.

Published on Jul 11, 2012

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing.

Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest, their cup size in an industry leader such as VS is not necessarily transferable to another brand.

Another point that is often underappreciated is that of anatomy and starting point. Any implant will add volume to the volume that is already present; the implant is additive. A particular volume will not necessarily confer the same cup size to different patients. Oftentimes, it will not even confer the same cup size to different breasts in the same individual. Remember, they are "sisters" not "twins".

A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential, representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals that do not correlate with these sorts of sterile volumetric assessments.

When sizing patients, there are a number of useful tools including:

-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)

-Breast sizers (rice bags)

-Goal photos

I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them, the overall cup size increase becomes less relevant. The key to obtaining a natural result is to stay within the parameters defined by your breast width diameter (BWD). This will ensure that you avoid the dreaded "fake" look.

Remember, love the "look" not the "cup."

As always, discuss your concerns with a board-certified plastic surgeon (ABPS).

Published on Jul 11, 2012

How to Best Determine the Optimal Breast Implant Size

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices.

This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate: a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant.

Further, simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in a bit.

Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors.

For more than 25 years, I have tried just about every method to best understand and achieve the patient’s optimal goal. The following is what I have found to be most accurate: To start with, I have found it most helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. This gives me detailed standardized views and information both qualitative (shape, perkiness) and qualitative (size) and allows me to discuss with my patients how I can best achieve their objectives as well as realistic expectations. For example, though I always tell my patients that I cannot make them exactly the same as a photo because everyone has different anatomical constraints.

However, these ”ideal” breast photos are brought to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to best achieve their wishes. Even if the photo does not match their height or weight, I and most plastic surgeons are very good at translating the proportionality of the photo to your features.

I personally order more than one set of implant sizes and use sterile implant “sizers” (temporary implants) placed in the created implant pocket during surgery to know in advance exactly which implant would work best for you in both a sitting and lying down position. This also allows me the opportunity to modify the pocket to meet some of the more subtle shape features desired. This enables me to use my full artistic potential to achieve your desired goals.

Published on Jul 11, 2012

There is no correct answer for exactly how many "cc's" will both look natural on you and make you happy. These are both great goals, but without having you present in person to evaluate, the answer becomes much more difficult.

I have patients do "sizing" with different sizes of breast implants on their preoperative date and make sure they go up the size scale until they are a clear "no" and then back down in size until they feel the implant is too small. We do this in a postoperative bra with a thin top on so the patient can see themselves in the mirror and get an idea of what to expect from a particular size implant.

You have lots of time from your pre-op until surgery, and I stress to my patients that they can come back as many times as they want/need to so that they can evaluate and then re-evaluate. I also ask them to provide pictures of someone with the breast size they think they would like so I get an idea of what size breast they are seeking.

I take all that information in and then give them my input as to whether their goals are realistic and achievable. Ask your surgeon what he or she recommends and let that assist you in making the best decision.

Hope this helps.

Published on Jul 11, 2012

If you are 32 inches in circumference at your chest, a C cup would be 390 cc and a D cup would be 480cc total volume. Your A cup breast probably are 240 cc, so you would subtract that from total volume to estimate the volume you need.

Published on Jul 11, 2012

In general, one bra size increase is approximately 200 cc's, but the final breast size depends on the implant, the amount of breast tissue, the style and manufacturer of the bra, and the patient's alternating monthly breast swelling. The same breasts can usually fit nicely in different sized bras. So don't worry so much about the letter on the back of the bra. Worry more about the physique staring back at you in the mirror and be sure that you have a high chance of achieving your pre-surgical goals.

Published on Jul 11, 2012

Every about 120-150cc is about one cup size, so you can roughly figure out what you will have. Good luck!

Published on Jul 11, 2012

I get this question all the time from my patients and my answer is that there is no direct correlation between cc's and bra size. Part of that problem is that sizing of bras has changed a lot over the past 10 years and cup filling is not the old reliable way it is done anymore. Mostly your bra size is determined by the width of the breast at the fold. That will certainly change with any implant.

I allow my patients to "try on" a wide range of implants using a sports bra and demo implants we keep around just for that purpose. I am amazed at what this reveals about my patients. People just like you, who I might have thought would choose a certain size, wind up liking a bigger implant fairly often--and I give them what they want.

Secondary surgery with implants in some studies is as high as one out of three patients, many of whom weren't satisfied with the size of their implant. By trying on implant sizers, I get a far lower dissatisfaction rate. Your surgeon should allow you to be happy as well. If you haven't been able to pick a size at your next visit, maybe think about a different surgeon.

Published on Jul 11, 2012

This is going to seem strange to say, but I would not focus on cup size. I understand that this is how we are conditioned to "judge" breasts, but it is far from a scientific measure. Cup size varies from one bra manufactuer to another. You may fit well into a C cup bra made by one company and yet a D cup fits you better in another company's bra.

Your chest circumference also plays a role in cup size. For instance, a smaller-chested woman like you, who is a 32 and chooses implants in the high 200 cc or low 300 cc range, may fit into a C or D cup bra, whereas somone who is a 36 or 34 chest with the same implant is a full B or low C. I have even had patients with 32 chests and 330 cc implants tell me that they bought DDD bras at Victoria's Secret, yet they look nothing like what you would think a DDD would look like.

Important questions to ask your surgeon are:

1) What implant best fits my frame?
2) How wide is my chest and how high do I want fullnes to go relative to my breast fold?

Implants have dimensions. Use these as a guide relative to your frame. Finally, be honest about the look you want. Do you want to look more natural or more fake? If you want to look more natural, stay within the confines of what your body dictates will fit. If you want to look more fake, push it beyond those limits.

Published on Jul 11, 2012

Cup size is impossible to predict. Victoria's secret is always a larger cup size than Nordstroms.

Published on Jul 11, 2012

If your surgeon hasn't told you yet that there is no correlation between implant volume and cup size, that's unfortunate. You need to return to his office and get sized in front of the mirror with a tight, unpadded bra and sizers/implants. This will let you know how you will look, which is much more important than a bra size.

Published on Jul 11, 2012

Best thing to do is communicate with your surgeon. I ask my patients to bring in pictures of breast sizes that they like and even dislike. I never talk about "cup size," as this can vary for each bra maker. I review these photos with the patient and discuss if it is reasonable with their body type, size, etc. I take these photos to the operating room with me and when the patients is on the operating room table, I use temporary sizers to view how different cc's look on the patient. I sit the patient up on the operating room table several times and compare them with the photos that they have chosen. When I see that I have achieved the patient's goals, I remove the temporary sizers and put in the implants. There is no guess work. I have all sizes from both manufacturers available to me at all times. This procedure takes more time BUT gives more exact results. I hope this helps.

Published on Jul 11, 2012

You should ask your doctor to see photographs of what you will get. Be sure to show him what you expect the outcome of your surgery to be.

What is the look and size you want? It helps to have photographs of your own that you can share. Clearly state all of this to your surgeon and have him or her reiterate it back to you prior to the procedure. This will better ensure the two of you are on the same page.

If you are unclear about what size or cc, then you should consult your doctor, not the internet because the only one who has actually seen your body and actually knows it is your doctor. Good luck!

Published on Jul 11, 2012