My approach to selecting a size for one's breast augmentation is that it is the patient's choice. It is not for me to judge someone's taste or desires. Breast size is a very personal issue and it is, to some degree, a bit like art. Beauty (breast size) is in the eye of the beholder. My goal is to make the patient happy. I usually do this by asking the patient to show me pictures of what size they think looks good and then I try and match that size concept in the surgery. The only preoperative measurement that carries much weight to me is the base diameter of the patient's breast. I have found few women want a breast implant that goes too far to the side and gets in the way of arm movement. Therefore, I keep the breast implant size to no greater than the existing breast base width. If the size is going to exceed the breast base width, that is one good reason to go with a high projecting breast implant so that one's breast volume comes forward and less to the side.
In the majority of breast augmentation in my practice, I find that most women select sizes that would be viewed as 'reasonable'. Most of my breast augmentation patients choose breast implants in the size range of 300cc to 450cc. The rest of my breast augmentation patients get implants in the 450 - 700cc size range. In a taller and heavier patient, these breast implant szies may appear not unduly large. For smaller women, these breast implant sizes would be considered quite large.
While it is not my concern when a patient chooses alarge breast implant, I have an oblication to inform them that there are some long-term consequences to that choice. First and foremost, it is easy to increase the size of the breast but it is difficult to go the other way. To go down in breast szie later in life, the excess skin may also have to be reduced to maintain a good breast shape, resulting in breast scars. Secondly, the larger the breast implant, the more loss over time the patient will have of their remaining breast tissue, otherwise known as pressure atrophy. In many large breast implants over time, the patient will only be left with skin and a breast implant with little breast tissue in between. Lastly, the weight of a very large breast implant over time may cause the entire breast to sag, weakening the skin support of the breast under its own weight.
Patients who choose large breast implants also need to appreciate that a woman's perception and goals of her breasts will change throughout her life. Like that nice cute tattoo that was put on in your twenties, it may not look so cute when you are forty.
